Inspection on 23/08/06 for Hembury Fort House

This inspection was carried out on 23rd August 2006.

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

Hembury Fort House 08/12/05

Hembury Fort House 12/04/05

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 Michelle Oliver Key Unannounced Inspection 10:00 23rd August 2006 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 Hembury Fort House DS0000021945.V302501.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. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hembury Fort House Address Awliscombe Honiton Devon EX14 3LD 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) 01404 841334 Mrs Agnes Olive Taylor Mrs Caroline Valerie White Care Home 25 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (25) of places Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2005 Brief Description of the Service: Hembury Fort provides accommodation and 24-hour care for up to 25 older people who may have dementia. The building is an adapted Georgian country house set on a hill within 8 acres of grounds, outside the village of Awliscombe and several miles from Honiton. Accommodation is over 3 floors with a passenger lift to all levels. All residents have spacious single rooms, with high ceilings of a unique character. Many rooms have wonderful views across the Otter Valley. The home’s statement of purpose and service user guide, which includes details about the philosophy of the home and details about living at the home, is made available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £306£415, weekly. Services not included in this fee include hairdressing, chiropody, newspapers, transport, incontinence aids and toiletries. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Thursday 23rd August 2006 over a period of 7 hours. Several residents contributed to the inspection, as did the manager and staff members. Prior to the inspection 25 surveys were sent to residents and 20 to staff members. All responses were generally positive. Twenty-five were also made available to relatives, visitors and health care professionals. All who responded were very happy with the care their relatives received at the home. Some comments were made relating to communication problems with concerns that not all staff understand what residents want. As part of the inspection, three people were case tracked; this means that three residents were asked about their experience of living at the home, their rooms were visited and the records linked to their care and stay inspected. During the inspection, a tour of the building took place and records including fire, care plans, staff recruitment, training and medication were looked at. Time was spent talking to residents individually and in a small group, and a period of time was spent observing the experience of residents sitting in one of the lounges. What the service does well: Staff treat residents as individuals aiming to make their lives as independent and fulfilling as they can. All residents spoken with praised the care they received from the staff and said they were very happy living at the home. A resident said “I would like to thank them for their kindness and help”. Comments included in questionnaires returned by relatives included “the attitude in the house is very relaxed, my relative can have what they want and is well cared for”, “residents always seem to be well cared for”, “staff are always approachable and in attendance” and “ one thing the home does really well is try to encourage freedom of choice and emphasis is put on the fact that residents rights and needs should come first”. The home was very clean and fresh; residents said this was always the case. Residents praised the quality and variety of the meals served at the home. Residents are supported and stimulated to take part in the home’s comprehensive activities programme. The owner, manager and staff are committed to providing and taking part in training to enable them to be up to date, competent and able to meet residents health, social and welfare needs. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 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. Hembury Fort House DS0000021945.V302501.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 Hembury Fort House DS0000021945.V302501.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3, 5 & 6. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Care needs are fully met following thorough assessments. EVIDENCE: Some residents had been living at the home for a number of years and some others could not recall the admission process but were happy living at the home and with the care they receive. Some residents spoken to say that they were given enough information about Hembury Fort House before making a decision to make it their home. Five questionnaires returned by residents prior to the inspection stated that they had not received a contract. This was looked into during the visit, as all residents should be informed of the terms and conditions of the home when they move into the home. It was found that these residents were funded and therefore had a contract with Social Services. The manager confirmed that residents who have such a contract are given a Statement of the home’s Terms and Conditions, which clearly describes all aspects of living at the home. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 9 No resident is admitted to the home without an assessment of their needs being undertaken. The assessment records of one recently admitted resident, and two for current residents were examined. All included comprehensive, detailed information to assess whether individual health, welfare and social needs can be met at the home. Care plans, giving clear information to staff to enable them to carry out care in the manner preferred by the residents, are formed on the basis of the assessments. Potential residents and their family or representatives are encouraged to visit the home at a time to suit them to look around, meet the residents [with their agreement] and to have a meal if they wish. The home does not admit people who require intermediate care. Hembury Fort House DS0000021945.V302501.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 7, 8, 9 & 10. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Individual care plans have been developed for all residents and all aspects of health; personal and social care needs are identified. Medication is well managed. Residents’ privacy and dignity are met and promoted by the staff and management at the home. EVIDENCE: As part of the inspection, four people were met and where possible conversation took place about their thoughts on the service. Their care plans were looked at and discussed with the manager. The home is continually working towards improvement and care plans have improved since the last inspection. Daily records were detailed and appropriately worded, and reflected discussions with residents about their care needs. Residents who are able and agreeable are involved in regular reviews of Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 11 their plans of care undertaken by the manager and staff at the home; relatives or representatives are also consulted. Surveys completed by sixteen residents stated they always received the medical support they needed and five said they usually did. The manager has good procedures in place to ensure that expert medical advice is sought on all occasions where risk or health care concerns are identified. For example as part of the care planning process an assessment of a residents nutritional needs is undertaken. If it is assessed that the resident is potentially at risk because of their diet, due to a reduced food intake, excessive weight gain, medical problems such as diabetes or a swallowing or dental problem, the manager refers the resident to the appropriate health professional. The manager described a good relationship with health professionals such as district nurses, community psychiatric nurse, pharmacist and doctors. The manager has worked hard to promote the importance of good communication amongst the staff team regarding the needs of residents. This includes regular morning and evening handovers and twice daily staff meetings, both of which are held in an area that maintains confidentiality. A staff member was positive about the level of communication within the home, and the teamwork that took place, which was felt benefited residents by the continuity of care at the home. The home has a good medication system in place that is well organised, and includes photos of residents kept with the administration records. This reduces the risk to residents, who are not always able to confirm their identity, of receiving incorrect medication. All medication received at the home is recorded and signed for by two members of staff. Some staff are currently undertaken training in the administration of medication. A member of staff said that they were waiting for the result of the last part of the examination to complete the training. Medication administration sheets were appropriately completed and medication stored safely. The procedure at the home protect residents from the risk of errors being made in the administration of medication. The manager undertakes a monthly “in house” audit of the homes’ medication policy and procedure. For example she has recently audited medication administration records. Some deficiencies were found as a result of this which have been since been improved thereby further protecting residents by ensuring that they all receive the correct medication at the appropriate times. The ordering of residents’ medication is undertaken by staff at the home. The prescriptions are then sent to the dispensing pharmacy from the GP surgeries Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 12 and are not checked against the items that were ordered before they are submitted. It is considered essential to have sight of this, as it is the only document signed by the prescriber confirming their instructions. This was discussed with the manager who immediately agreed that the home’s procedure would be changed to meet this recommendation. Residents’ privacy and dignity are met and promoted by the staff and management at the home. Several members of staff were spoken to during this visit, including ancillary staff. All were able to describe good standards of respecting residents’ privacy and promoting their dignity. Generally residents spoke positively about the attitude of care staff who they described as kind. One person said that they were happy with the way that personal care was provided, which did not make them feel embarrassed. Toilets and bathrooms are lockable to promote residents’ privacy and dignity. However, these are not able to be opened from outside the rooms in the case of an emergency. This was discussed with the manager who agreed to look into alternative devices. The manager said that no residents are currently able to be left alone when bathing and very few are able to visit a toilet without staff assistance. However, during this visit the inspector heard a resident say that they were “frightened” of going to the toilet alone as they had recently locked themselves in”. In written surveys, twenty-one people said that they felt the staff listened and acted on what they said, but one person felt this was not the case. During the inspection, it was observed that some staff did not always talk to residents. The manager said she has provided training in listening skills and communication, and was able to demonstrate a good understanding in this area of care. She said she would be revisiting this skill with staff. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 13 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): OP 12, 13, 14 & 15. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Social needs and meals are generally well managed. A varied balanced diet is provided served in a pleasant atmosphere. Residents are encouraged to maintain contact with their families or friends as they wish and to take as much control of their lives as they are able. EVIDENCE: Care plans contain detailed information from which individual residents’ preferences, needs, likes and dislikes can be addressed. Residents’ life style at the home, including getting up and going to bed and mealtimes, appeared to be flexible. Many residents were able to confirm that they were encouraged to make choices at the home and that they decide how they wish to spend their day. Staff said that there were no routines at Hembury Fort; residents can do “what they want, when they want”. Staff were seen responding to residents individual choices such as giving drinks whenever asked for and not just at “tea time”. Residents’ interests, preferences and a record of activities that they have taken part in are included in care plans. An activities organiser has been employed at Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 14 the home covering 13 hours a week. She said that she “would like more time” as there is so much that she would like to do for the benefit of the residents. During this visit the inspector spent a period of time in the lounge observing residents and staff. Most residents were enjoying listening to music. The activities organiser used this time to talk to residents about what memories the music evoked. Several residents spoke about their family, their previous occupations and events which the music reminded them of. A member of staff involved a resident in doing a crossword and after a short time a number of other residents joined in. Some residents who did not like the music were engaged in other activities. Most staff interactions with residents were generally good, and residents responded well to their kindness. However, it was noted that a member of staff approached a resident to remove some items from their table and did not acknowledge them or speak to them. A number of residents were given afternoon tea with no interaction from another member of staff. This was discussed with the manager who immediately agreed to address these issues with the staff concerned. Information received before this visit indicates that church services, craft activities, painting, bingo, exercises, reminiscence therapy, quizzes, and ball games are provided at the home. Residents visit local shops and a library if they choose. The activities organiser discussed plans to introduce Tai Chi sessions at the home, to help residents undertake gentle exercise and aid relaxation. During this visit staff and residents discussed a planned outing, which they are all looking forward to. Activities are amongst the topics discussed by residents at the regular meetings held at the home. One questionnaire stated that a resident would like “more card games”. Twenty questionnaires received from residents stated there were always or usually activities arranged by the home that they can take part in. One questionnaire stated there were never any activities. Seven questionnaires were received from visitors or relatives; all confirmed that they were made welcome at the home. Dietary needs have been well addressed; diets are well monitored and a record is kept of food which has been eaten by all residents to enable staff to identify any potential problems promptly. The cook was able to discuss various special dietary needs and confirmed that they would contact a dietician if advise were needed. A menu is clearly displayed in the lounge and they are given a choice of evening meal. The cook said that if a resident doesn’t want what is on the menu a meal of their choice will be prepared. The meal served during this visit was nutritional, hot and well presented by staff in a pleasant dining room. Menus are one of the main topics discussed at residents’ meetings. As a result of comments made by residents at the last meeting spaghetti bolognese, hot dogs and pizza have been added to the menu and curry will be “hotter” Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 15 Twenty questionnaires completed by residents stated that they always or usually like the meals at the home; one commented, “Always finish my plate. Would like more dessert” another “the food is out of this world and staff always present it so well”. One questionnaire indicated that a resident “never like the meals”. A questionnaire completed by a relative stated, “The food is always good, and I often eat it myself”. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 16 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): OP16 & 18. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints process. Most staff were able to demonstrate a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: A questionnaire completed by a local doctor confirmed that they had not received any complaints about Hembury Fort House. Information received prior to this inspection indicated that one complaint had been made directly to the home. This was looked into by the manager promptly and records of the investigation were seen by the inspector. The complaint was valid and the manager has taken steps to prevent a reoccurrence. The home’s complaint procedure was complied with. Some residents said that they would go directly to the manager if they had a concern or complaint; others felt the care staff on duty could address these and one said that they would deal with the person “direct”. A record is kept of any issues of concern raised at the home. A complaints book is available in the entrance to the home where comments can be made anonymously if preferred. Many of the residents would need assistance to follow the home’s complaint procedure and staff are aware of this. To ensure that residents are not unhappy staff are able to describe how they note that individual residents are not happy or concerned about anything. The home operates an “open door” Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 17 policy and residents were seen during this inspection visiting the office with issues, which concerned them. At all times they were treated with patience and consideration and their problems were dealt with efficiently and quickly by the manager and staff. Two questionnaires returned by residents said they were not sure how to go about making a complaint whilst another said they “don’t need to complain”. One resident when asked whether staff act and listen on what residents say wrote, “When I make some of them understand”. There was nothing to suggest that residents are anything other than well cared for at the home. Residents said that staff were very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training since the last inspection but not all were able to discuss different forms of abuse. Most staff said that they would not hesitate to report any suspicion of poor practice. This was discussed with the manager who thought this inability was due to a language problem rather than lack of knowledge. [Refer to standard 27] Discussion took place with a staff member, who was clear about their responsibilities to ‘whistle-blow’, or report, poor practice and who to contact within the home. The manager confirmed that she and all staff have undertaken Protection of Vulnerable Adult training in the last year but intends to update this. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 18 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): OP 19, 25 & 26. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The home is generally clean, pleasant and homely and generally meets the needs of the residents. Environmental risk is well managed. EVIDENCE: The home is generally well maintained, and the manager said that since the last inspection various bedrooms had been redecorated. However, some of the decor in the home is looking tired and would benefit from redecoration. The manager said the home has a programme for redecoration and improvement. Future plans include replacing the home’s roof, creating a new office, increasing the size of the home by creating new rooms and refurbishing the whole building. There is little evidence at this time of adaptations, which would help residents with dementia to maintain independence and promote wellbeing. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 19 Ten residents’ rooms were visited during the inspection, and these were all well maintained. Residents’ rooms are individualised and provide ample space for them to bring personal possessions and items of small furniture when they decide to make Hembury Fort House their home. It was noted in a resident’s room that wallpaper was peeling from the ceiling and a light in the ensuite was not working. Lighting was dim on a corridor and it was found that the bulbs also needed replacing. The home employs a person to undertake maintenance at the home; staff records any tasks in a book, which the maintenance person checks regularly. The home has a large lounge loosely divided in to two areas and a large dining room. Ample space is available for activities and for those who like to walk or have mobility problems and need the use of a wheelchair. Because of the age and design of the building some upper floors in the house slope, and there are other hazards common to period buildings such as steep stairways. Safety has been improved through better maintenance and the home’s approach to hazard management. Only two radiators are waiting to be fitted with covers to protect residents from the risk presented by hot surfaces. The home was generally clean and fresh. Residents commented positively on the cleanliness of the home, and this was observed on the day of the inspection. In questionnaires, sixteen residents responded that the home was always clean and fresh, and six residents said this was usually the case. A relative said, “ it is an old building, they do their best”. There is a good supply of protective clothing and hand-washing facilities at the home and the laundry has equipment, which should effectively reduce the risk of cross infection. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 20 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): Op 27, 28, 29 & 30. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The number of staff on duty throughout the day and night meets residents’ personal and health needs. Residents benefit from being cared for by staff that are qualified and competent and are protected by the robust recruitment practice followed at the home. Attention is needed to ensure that communication skills and understanding are developed and maintained by all staff at the home. EVIDENCE: On the day of the inspection a cook, a domestic, a senior carer, four care staff and the manager were on duty throughout the morning. In the afternoon, this changed to a senior carer, three care staff, an activities organiser and the manager, and in the evening one senior carer and one member of care staff. The rota shows that there are two waking staff on duty throughout the night until 7am. Ten residents who returned questionnaires felt there are always enough staff to care for them and twelve felt that there usually were. A questionnaire returned by a relative commented, “I do sometimes notice there doesn’t seem enough staff to meet the residents’ demands”. One staff members wrote in Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 21 their written response that they would like more time to spend with residents to engage them in interests and activities. The manager has promoted the role of key workers for each resident with the aim that they know they get to know the resident well and support them with personal tasks. This works towards meeting the homes’ ethos of maintaining person centred care for all residents living at Hembury Fort House. As part of their development some staff will be continuing to improve and develop their communication skills and levels of understanding. Comments in questionnaires received from relatives included “I worry that some members of staff don’t understand what the residents are asking”, “ this can lead to communication difficulties over complicated issues”. However, comments also made included, “I think the level of care is very good. The staff attitude is excellent and I always find the home has a happy, friendly feel” and “however, any problems are more than offset by the extremely caring attitude and attention given to our loved one”. The manager has undertaken a survey, which has sought comments about communication from relatives and has acted on the responses. According to the pre-inspection information, 22 of the care staff group have an NVQ2 in care or above, which is a good achievement. The manager is committed to training and discussed plans for staff to continue to undertake NVQ training. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know the residents, the home’s philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. The manager has shown a strong commitment to promoting training within the staff group by providing in-house training and at staff meetings. According to pre inspection information training undertaken in the last in last 12 month includes safe moving and handling, food hygiene, falls awareness and prevention, first aid, protection of vulnerable adults abuse and dementia awareness. Training currently being undertaken includes medication training, safe wheelchair use, oral hygiene and infection control. Training planned to take place during the next 12 months include first aid refresher, food hygiene and dementia awareness updates. Ensuring that residents are cared for by a competent team of staff further promotes person centred care and safety. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 22 Replies from staff members, when asked if they could change one thing to improve the home included, “I would not change the care home, only improve on my understanding and training”, “if courses come up that I’d like to do, it would be arranged which improves my knowledge and resident care” and “my employer actively encourages training”. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Three staff recruitment files were looked at during this visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. This protects residents, as only people who have undergone this robust procedure will be employed to work at their home. Thirteen staff confirmed in questionnaires that they had all undergone a thorough, robust recruitment procedure. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 23 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): OP 31, 33, 35, 36 & 38. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home is well managed, run in the best interest of residents, and their health and safety are properly attended to. EVIDENCE: The manager has experience of working with older people since 1987 and in a managerial capacity since 1989 when she became the owner of a care home. She and a partner took over as owners of Hembury Fort House in 1998. She completed a Registered Manager’s Award in May this year and has a positive attitude towards training. Thirteen members of staff said in their written responses that they felt well supported by the manager. Two responses stated “we all work well as a team and give each other support”, “the manager is very approachable in all circumstances” and “ the manager is very understanding and supports all staff Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 24 in a great many ways, always has time for all of us”. Several residents said that they felt the manager was approachable and is always available during the inspection the manager demonstrated good knowledge about the needs of residents A quality adult has been undertaken since the last inspection to gather views of residents and visitors on various topics related to the running of, and the quality of life experienced at, the home. The minutes from residents’ meetings show that they are held regularly, and that residents’ involvement is actively sought. Residents are encouraged and supported to manage their own money whilst living at the home. The home manages personal allowances on behalf of some residents who are unable, or choose not, to look after it themselves. The money is kept securely with records and receipts of expenditure maintained. Thirteen staff members wrote in their surveys that they had formal supervision and that as part of supervision their practice was observed. Induction records were seen for new staff, as well as appraisals for other staff. In their written response, thirteen staff members said that they were clear about the home’s policy on confidentiality and the disciplinary procedure. Hot water temperatures are recorded regularly and communal bathrooms have thermometers. The temperature of bathwater poured for a resident was checked and found to be within the recommended guidelines. All first floor windows checked were fitted with window restrictors promoting safety within the home by reducing the risk of residents falling from them. Fridge and freezer temperatures are recorded which is good practice. Staff involved in food preparation confirmed that they had food hygiene qualifications. Ten residents’ rooms were visited and radiators had been covered to promote the safety of residents. The manager confirmed that most radiators in home had been covered. Records show that staff undertake training in the prevention of fire, and fire alarms and emergency lighting have been carried out regularly. An assessment of identified hazards and associated risk relating to the environment, including fire hazards, has been undertaken which contribute towards ensuring that Hembury Fort House is a safe place to live. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 25 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 3 3 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 3 X 3 X 3 3 X 3 Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 The manager sees the prescription form before sending it to the pharmacist for dispensing. [See narrative standard 9] All locks should be able to be opened from the outside in the case of an emergency. All staff should be able to confirm understanding of the home’s protection of vulnerable adults procedure in relation to forms of abuse and reporting of incidents and all other training undertaken. Environmental changes to the home and gardens should be based on current good practice environmental guidelines for care homes providing dementia care. 2. 3. OP10 OP18 OP19 4. Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 27 OP19 5. All parts of the home should be reasonably decorated. [This refers to the ceiling wallpaper peeling in a resident’s room and general décor needing redecorating throughout the home.] Hembury Fort House DS0000021945.V302501.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Exeter Suites 1 & 7 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. 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