Inspection on 12/04/05 for Hembury Fort House

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hembury Fort House 23/08/06

Hembury Fort House 08/12/05

Hembury Fort House 26/10/04

Hembury Fort House 28/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hembury Fort House Awliscombe Honiton Devon EX14 3LD Lead Inspector Anita Sutcliffe Announced 12th April 2005 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. Hembury Fort House Version 1.00 Page 3 SERVICE INFORMATION Name of service Hembury Fort House Address Awliscombe, Honiton, Devon 01404 841334 01404 841334 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 Agnes Olive Taylor Mrs Caroline Valerie White Care Home 25 Category(ies) of Dementia(25). registration, with number Old Age. not falling within any other of places category(25) Conditions of registration Date of last inspection None 3rd March 2005 Brief Description of the Service: Hembury Fort House cares for 25 older people, who may have dementia. Health services are provided by doctors and visiting nurses on a domiciliary basis. The building has been adapted from a large Georgian country house, which dates back in part to 1630. It is set on a hill within 8 acres of landscaped grounds, to which residents have access. The home is on 3 floors with a passenger lift to all levels. All residents are accommodated in spacious single rooms, with high ceilings and of unique character. Many rooms have wonderful views across the Otter Valley. Hembury Fort House Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 ½ hours, with the pharmacy inspector present for 4 ½ hours. Complaints and concerns raised about the home over the past 8 months have led to increased monitoring by the Commission which have included additional unannounced visits and a formal review meeting with the home’s providers, Mrs. A. Taylor and Mrs. C. White. The inspection was announced as an opportunity for the providers to demonstrate the improvements they have assured, and was 6 weeks from the last unannounced visit. The inspection concentrated on the care of more vulnerable residents, many with dementia, who were therefore less able to communicate their views and feelings about the home. Prior to the inspection the home had completed a pre-inspection information questionnaire. During the inspection I looked around the building and met residents in their rooms, lounge and dining room. 3 residents had their care tracked. This involved meeting them, discussing their needs with their keycare worker and reading their care records. The pharmacy inspector looked at the home’s medicine arrangements. This involved long discussion with providers and senior carers. Both inspectors spoke to many care staff with 3 interviewed at length. Specific time was taken to watch staff interacting with residents. There has been ongoing information gathering from health and social care professionals who visit the home, and residents’ family had the opportunity to comment on the home. What the service does well: Staff clearly care for and understand the residents as individuals. This is observed at every inspection visit and supported by the detail in the home’s assessment records. The method used to plan care and record information is well thought out and effective when used as designed. The home is always clean, fresh, warm and homely. Residents’ rooms are individual and personalised; and adaptations have been made so as to meet personal taste and preference. The registered providers accept that the home fails in certain areas, honestly reflect on why this occurs, and work with the Commission toward improvement. Hembury Fort House Version 1.00 Page 5 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hembury Fort House Version 1.00 Page 6 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 Hembury Fort House Version 1.00 Page 7 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) 3, 4 and 6 Residents, including those with dementia, benefit from good assessments of their needs but it was not evident who has been involved in the assessment. The Standard concerning Intermediate Care does not apply to Hembury Fort House. EVIDENCE: Careful assessment of residents’ needs are made which provide good information from which staff can plan and deliver care. The assessments help staff understand the particular needs of residents with dementia. A new system for prompting additional assessments from health care professionals, such as dieticians or district nurses, has been introduced. Staff have had training in dementia care from the Alzheimer’s Disease Society and they showed a good awareness and empathy for residents. Residents were clearly comfortable with the staff and the atmosphere in the home was relaxed. Residents have access to a variety of communal spaces including a large sitting room. There is plenty of space for residents to walk unconfined. The front door of the home is never locked. The inspector was assured that Hembury Fort House Version 1.00 Page 8 the home does not admit people who are included to wander away and that the risk of doing so is specifically assessed. Hembury Fort House Version 1.00 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 standard(s) 7,8,9 and 10 Plans of care were satisfactory and residents’ health care needs were being met. Staff treat residents with dignity and respect. The system used for the recording and storage of medicine to be administered to the Residents had the potential to place the residents at risk. EVIDENCE: Each resident has a care plan and a ‘key’ worker. Care plans have improved since the last visit and 2 ‘key’ workers spoken to understood the needs of their residents. Records were seen of health care appointments and visits by a district nurse. Daily records provided detail on how care is delivered, including the diet taken. Each service user looked well cared for. Residents who were able to contribute to the inspection said that they were happy with the care they are receiving, but most were unable to do so. Care staff were observed showing respect for residents and their right to privacy. Hembury Fort House Version 1.00 Page 10 The arrival of prescribed medicines is not recorded and this was confirmed by members of staff. The administration of controlled medication was not recorded in accordance with the policy of the home, giving rise to concern that medication had gone missing. An immediate requirement was made for recording to be undertaken properly. Medicines were not all securely locked away. Risk assessments had not been undertaken on all service users looking after their own prescribed medicines. Procedures able to ensure the proper training of staff handling medicines were not in place. Internal audit arrangements on medicines handling need to be introduced. Some medication was unlabelled, although this was seen to be caused by the method of labelling used by the supplying pharmacy. Hembury Fort House Version 1.00 Page 11 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) None of these Standards were inspected on this occasion. EVIDENCE: Hembury Fort House Version 1.00 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 standard(s) 16 and 18 Many residents would be unable to follow a complaints procedure without assistance, and the home is not succeeding in making the complaints procedure sufficiently accessible to visitors. Staff understand the need to protect vulnerable adults from abuse. EVIDENCE: The home has a complaints procedure. No complaints have been made directly to the home. 2 complaints have been received by the Commission since August 2004. Investigation by the Commission identified areas where improvement was necessary and the home has produced an action plan setting out how this will be achieved. As the Commission has received complaints but the home has not it brings into question the openness of the home to receive and act on complaints, or the adequacy or availability of the complaints procedure itself. Staff talked confidently of their understanding of adult abuse issues. The providers have provided training and taken steps to lesson the likelihood of service user aggression toward other service users, which has reduced to nil in recent months. Hembury Fort House Version 1.00 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 standard(s) 19, 21,23,24,25 and 26 Residents live in a homely and unique environment which they enjoy, but it is not safe and well enough maintained in all areas. EVIDENCE: Residents’ rooms are wonderfully unique and provide the space they need to bring a variety of personal possessions to the home. Locked boxes have now been provided for personal possessions, and residents who keep their own medicines have lockable storage space for them. Residents say how much they like their rooms. There is ample space for different activities and for those who like to walk to unescorted residents due to some steep slopes and, in some parts around the base of the building, wear to pathways. Some upper floors in the house slope, and there are other hazards common to period buildings such as steep stairways. The inspector found a lamp plug in an unsafe state, a loose handrail on the corner of a steep stairway, and the passenger lift does not have an inner door. Hembury Fort House Version 1.00 Page 14 The owners check and assess risks in residents’ rooms, but not to the degree or frequency necessary. Fire prevention is properly attended to. The inspector was told that fire safety and environmental requirements had been met. Some rooms continue to have unguarded radiators which pose risk of burns from hot surfaces. However, the risk is assessed and the requirement to cover them is being met within the timescale agreed with the home. The heating and lighting Standard was not inspected in full. Hembury Fort House Version 1.00 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 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) 27,28,29 and 30 Residents’ needs are broadly met by the number of staff and their experience and skills. A small number of staff from overseas have little or basic English which may be compromising residents’ care and safety. EVIDENCE: Recruitment and induction records were examined and satisfactory. Training provided was also broadly satisfactory, but the home employs some staff from abroad who have poor English and for whom the effectiveness of induction and other training may be reduced. Staff are encouraged to undertake NVQ qualifications, but to date only 20 of care staff have NVQ level 2 awards, which falls short of the 50 training standard expected of care homes. Hembury Fort House Version 1.00 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 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 and 38 The home is not managed with sufficient care, competence and skill to ensure the health, safety and welfare of residents. EVIDENCE: In response to the Commission’s concerns about the management of Hembury Fort House one of the owners has arranged to take the Registered Manager’s Award. Learning about good leadership and management practice has been undertaken and the decision taken to delegate responsibilities. An additional staff post is planned so that management time may be spent more effectively. However, some serious health and safety concerns still exist (see Standards 9 and 19) which demonstrate a continuing failure to manage the home with the level of care, competence and skill required. Despite new arrangements to monitor safety the home was not maintained in a safe state, and there remains insufficient assessment to the management of risks; please see the Environmental section (p14 – 15). Furthermore, the owners were unable to find records relating to electrical safety at the home. Hembury Fort House Version 1.00 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 1 3 x x 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 1 x x x x x x 1 Hembury Fort House Version 1.00 Page 18 yes 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 9 Regulation 13(2) Requirement The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in to the care home. (Previous timescale of 18 March 2005 not met) An investigation must be carried out into the apparent discrepancy of a quantity of Controlled Medication and a regulation 37 notice must be sent to the CSCI local office detailing the findings and the action to be taken. The receipt of all medicines into the home must be recorded including the date of receipt. All medicines must be stored securely such that the person in charge of medication can only access it. 2. 19 23 The premises to be used as a care home must be of sound construction and kept in a good state of repair externally and internally. Version 1.00 Timescale for action Immediate 20 April 2005 12May 2005 12 May 2005 20 April 2005 Hembury Fort House Page 19 3. 25 13(4)(c) 4. 30 12(1)(a) Unnecessary risks to the health or safety of service users must be identified and so far as possible eliminated [this relates to pipe-work and radiators being guarded or having low surface temperatures] (This requirement was still within the timescale agreed) The registered person must ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. [This relates to the inability of foreign staff (with little or no understanding of English) to utilize information received through induction and training] The registered provider must manage the home with sufficient care, competence and skill. [This relates to the need for improvements to basic management practice, in particular to health and welfare] (Previous timescale of 03 March 2005 not met) The registered person must ensure that unnecessary risks to health or safety of service users are identified and so far as possible eliminated. (Previous timescale of 31 March 2005 not met) [this relates to: the lift being unsuitable for service users use unsupervised and not having been risk assessed the handrail on steps were 31 March 2006 12 May 2005 5. 31 10 30 June 2005 6. 38 13 Immediate 12 April 2005 14 April Page 20 Hembury Fort House Version 1.00 coming away from the wall the poor maintenance and servicing of electrical equipment] 2005 14 May 2005 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. 2. 3. 4. 5. Refer to Standard 3 9(7) 9(1) 16 28 Good Practice Recommendations It should be clearly recorded who has been involved at each stage of assessment. It is recommended that all staff administering medication have been appropriately trained and that they are regularly assessed for their competence. It is recommended that the home have in place an audit procedure to monitor that all records are made correctly. The home should display their complaints procedure where visitors would see it. A minimum ratio of 50 trained members of staff (NVQ level 2 or equivalent) should be achieved by 2005. Hembury Fort House Version 1.00 Page 21 Commission for Social Care Inspection Suite 1 Renslade House, Bonhay Road Exeter EX4 3AY 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. Extracts may not be used or reproduced without the express permission of CSCI Hembury Fort House Version 1.00 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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