Inspection on 08/12/05 for Hembury Fort House

This inspection was carried out on 8th December 2005.

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

The inspector 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 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 Anita Sutcliffe Unannounced Inspection 8th December 2005 10:00 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.V268246.R01.S.doc Version 5.0 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.V268246.R01.S.doc Version 5.0 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.V268246.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03/10/05 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 has 2 manager / owners with many years experience. Health care needs are met through local GP and nursing services. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection began at 10 am and took place over 5 ½ hours. The home has had 5 additional inspection visits from the Commission this year so as to monitor progress at the home following concerns identified and Standards not previously achieved. Most key Standards were therefore inspected on this occasion. The inspection involved assessing the care of 3 residents (service users). This was achieved through meeting them, visiting their room, reading records of their assessment and care planning and discussion with staff. All other residents were met during the inspection, but not all were asked their views. Each part of the building was visited. Lunch was shared with the residents. On arrival the newly appointed activities coordinator was planning the day’s activities; later a training assessor was assessing staff progress with their NVQ in care qualifications. All staff were spoken with and one interviewed. Records examined included care, fire safety, medication, staffing, training, complaints, quality assurance and accidents. Some policies and procedures were seen. The handling of medication was examined fully. One of the registered owner / managers was present throughout, gave information and full assistance. What the service does well: What has improved since the last inspection? Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 6 The owner/manager has worked hard toward continuous improvement at the home, recognising areas of failure, taking positive steps to address problems, and taking staff with her toward improved practice and standards. Safeguards are in now in place to ensure those residents’ needs are met in full. This includes changes in staffing arrangements, training, record keeping, moving and handling practice, improved hygiene management, quality assurance checks, improved complaints management and increased protection for residents through new door security. There is a newly appointed activities coordinator who is committed to enabling residents to lead a more fulfilled life. 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.V268246.R01.S.doc Version 5.0 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.V268246.R01.S.doc Version 5.0 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): 3&4 Care needs are fully met following thorough assessment and planning. Residents needs are met by the way the home is run. EVIDENCE: The assessment records of two recently admitted residents, and the initial assessment record for a resident not yet admitted, were examined. They contain sufficient detail to determine whether the home should be able to fully meet individual need. The home uses ‘tools’ to assess any degree of risk, such as that of poor appetite, risk of pressure sores or falls. From these assessments a plan is written on how needs are to be met in a consistent way. The home has a relaxed and caring atmosphere. Staff are unhurried and demonstrate sensitivity to residents’ needs. They receive training in how to care for and protect those with dementia. Where necessary outside advice is always sought from appropriate health care professionals, such as district nurses, nutritional and mental health professionals. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care is well planned, based on residents wishes, and health and care needs are exceptionally met by well informed staff. Medication practice at the home does not fully protect residents. Residents are treated with respect and with full regard for their privacy and dignity. EVIDENCE: Residents said they were well looked after and records showed that care was very well planned. The manager has been proactive in ensuring that expert medical advice is sought on all occasions where risk or health care concern is identified. Dietary needs have been well addressed, with staff receiving training; diets are well monitored. Equipment is provided to prevent pressure sores. All residents looked well cared for. Each resident has a key worker and the home has methods of ensuring that each aspect of health and care is guaranteed, not left to chance. Care plans have been reviewed monthly and those examined were accurate. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 10 Staff were observed knocking before entering bedrooms and a resident said that staff always treat her respectfully. A visiting training assessor said that staff treat residents appropriately, and she is very satisfied with the care she has observed at the home. Medication was once again examined in detail. Storage was safe and records were neat, but when checking these against the medication itself inaccuracies were found as tablets had been signed for which had not been given. Where hand transcribed entries were made some were not signed or dated, and therefore full audit was not possible. Where a medication had not been given the reason was not always provided. Some external medication found in bedrooms was still in use past its completion date. Staff are also taking telephone information about changes in medication. This leaves them open to mistakes. Each of the failings in medication management could adversely affect residents’ welfare. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Residents are supported to have a fulfilled life. Residents receive a nutritious, tasty diet, with special dietary needs understood and met. EVIDENCE: A newly appointed activities coordinator is making local connections and has many plans toward increased, appropriate activities. She says she is being well supported by the owner / managers. During the inspection an information board was being updated, followed by arts and crafts with residents. The lounge has the recent addition of a fish tank and a ‘resident’ Labrador who brought smiles to many faces. Outings and Christmas events are planned. Care plans contain detailed information from which individual preferences, needs, likes and dislikes can be addressed. Residents who could contribute to the inspection said they choose how they wish to spend their day. Daily events records confirmed that individual wishes lead rather than dictate staff routine. Visitors are always welcome at Hembury Fort and the owner / managers available for discussion. Staff were observed interacting with residents in a friendly and caring manner. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 12 The lunch provided was tasty and the meat very tender; the dining room attractively presented. One resident said: “the meals are quite nice, but I’d like a bit of a change”. The menu appeared to be rather too much ‘meat and two vegetables’. This was discussed with the manager, who said that it is currently under review. Assistance with eating was given where needed. The home’s approach to ensuring a balanced and appropriate diet was commendable (see also Standard 8). Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 13 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): 16 & 18 Residents benefit from the homes approach to complaints, and are protected from abuse. EVIDENCE: Many residents would be unable to follow a complaints procedure without assistance. To encourage comment about the home the complaints procedure, plus suggestions and comments books, are prominently displayed at the home’s entrance, and the manager / owners are frequently available for discussion. No complaints have been received at the Commission about Hembury Fort for many months. A resident said she felt quite safe at the home. Staff have received training in the protection of vulnerable adults and the home’s policies and procedures further protect them. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 14 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): 19, 25 & 26 The home is clean, pleasant and homely. It meets the needs of residents, but could be further adapted in line with current thinking in dementia care. Environmental risk is managed, but lack of attention to fire safety has the potential to put residents at risk. EVIDENCE: Residents’ rooms are wonderfully unique and provide the space they need to bring a variety of personal possessions to the home. Some rooms are more like apartments than bedrooms. There is ample space for different 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. Many of the radiators now have safety covers to protect Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 15 residents from hot surfaces, and there are plans to complete this within the timescale agreed with the Commission. There is programme of redecoration and improvement at the home. Several rooms have been completed. There is little evidence at this time of adaptations, which would help residents with dementia to maintain independence and promote wellbeing. 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. The home was clean and fresh. Fire safety equipment has been serviced and maintained fully. However, fire safety checks within the home had lapsed, not having been checked since the 11th October. Staff have received fire safety training, but night staff training has not been sufficiently frequent. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 16 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): 27, 28 & 30 Residents needs are properly met through the numbers and skill mix of staff. EVIDENCE: Residents felt there ere enough staff to care for them and the activities coordinator and NVQ assessor agreed. The atmosphere within the home was relaxed and staff were observed taking time to interact with residents and assist them. Training needs are more fully addressed at the home and many care staff are now undertaking the NVQ in care. As yet only one has completed this, but the manager commented on how staff are showing a lot of commitment to the training, and said: “their paperwork is impressive”. Staff Induction is undertaken methodically, and continual training is provided to equip staff to do their work well. Training includes: dementia awareness, protection of vulnerable adults, emergency first aid, moving and handling, specialist diets and quality assurance. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 The home is well managed, run in the bet interest of residents. Health and safety are not fully attended to. EVIDENCE: The manager/owners are commended for their attitude to improvement at the home. Staff understand their roles and responsibilities and have been supported to make improvements. The manager has undertaken training in Service Improvement and Quality Assurance so that improvements can be based on feedback from residents and their representatives. Questionnaires have been used, some themed and some with general questions about the home and service. The results are to be discussed at residents and staff meetings, it was hoped by the New Year. Residents are encouraged and supported to manage their own money. The home keeps some on their behalf. It was secure and with records and receipts Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 18 available. Residents are able to keep valuables in lockable storage boxes in their rooms if they wish. Health and safety have much improved at Hembury Fort through improved maintenance and staff training. Other than fire safety (see Standard 19) the only concern identified was the portable appliance (electrical) testing, which was started some months back but not completed. Cleaning chemicals are now kept locked away from residents who may be harmed through contact with them. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 19 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 1 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 4 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 09/12/05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. [This refers to: • Discrepancies over whether tablets have been given or not. • Hand transcribed information not signed. • External medicines used after use-by date. The registered person shall after 31/12/05 consultation with the fire authority make adequate arrangements for reviewing fire precautions, and testing fire equipment, at suitable intervals, and make arrangements for persons working at the care home to receive suitable training in fire prevention. [This refers to the lack of regular fire safety checks since October and because night staff have not received 3 monthly fire safety training] DS0000021945.V268246.R01.S.doc Version 5.0 Page 21 Requirement 2 OP19 23(4) Hembury Fort House 3 OP25 13(4)(c) The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. [This relates to pipe-work and radiators being guarded or having low surface temperatures] (This requirement is still within the timescale agreed). 31/03/06 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 Refer to Standard OP9 OP9 OP19 OP38 Good Practice Recommendations Hand transcribed information about medicines should be checked by a second member of staff. Changes in medication should not be made without written information from the health care professional making the change. Environmental changes to the home and gardens should be based on current good practice environmental guidelines for care homes providing dementia care. Portable appliance testing should be completed at the first opportunity. Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Hembury Fort House DS0000021945.V268246.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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