Inspection on 05/01/06 for Horsfall House

This inspection was carried out on 5th January 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

Horsfall House 24/04/06

Horsfall House 31/05/05

Horsfall House 14/12/04

Horsfall House 05/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 Horsfall House Windmill Road Minchinhampton Stroud Glos GL6 9EY Lead Inspector Mrs Janet Griffiths Unannounced Inspection 10:00 5 January 2006 th 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 Horsfall House DS0000016476.V260421.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. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Horsfall House Address Windmill Road Minchinhampton Stroud Glos GL6 9EY 01453 731227 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) Minchinhampton Centre for the Elderly Miss Jennifer Martin Care Home with Nursing (N) 42 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (22) of places Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary Variation to admit one named person under 65 years of age on a respite care basis one week in every six. 31st May 2005 Date of last inspection Brief Description of the Service: Horsfall House is a purpose built home accommodating elderly people who need nursing care, residential care or dementia care. The Home also provides a day centre offering a range of facilities for the elderly residents of the local community and is also open to the residents in the home by arrangement. The Home is situated on the outskirts of the town of Minchinhampton near to the common. The accommodation is attractively furnished and maintained. A shaft lift accesses the upper floor to the nursing General unit, which consists of 18 single and 2 double rooms, all with en suite facilities. The Cotswold (EMI) Unit comprises 20 single en suite rooms. The main dining room is situated in the front of the Home next to the kitchen and its aim was to provide for all residents in the Home. However, this is now used mainly for the Day Centre, as residents in the Cotswold (dementia care) unit and General unit have become frailer and are not able to access this room easily, and are at present using the limited facilities on the units. There are plans in place to address this in the next programme of redevelopment, when new dining room facilities are proposed. There are several attractive garden areas also available to the residents, which include a walled garden where residents from Cotswold Unit can wander in safety and a summerhouse, a popular meeting place for residents and their families. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours during one day in January 2006. The registered manager was present throughout the day. A tour of the premises was carried out and rooms were seen when residents were visited. A number of residents, two relatives and staff were spoken with during the inspection and a selection of care records and other documents were seen. The requirements and recommendations from the last inspection have been met. Sixteen National Minimum Standards were inspected on this occasion; thirteen were met, two almost met and one not met. What the service does well: What has improved since the last inspection? The care planning system although still under review is much more consistent between the units; Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 6 reviews are completed with the residents/their relatives wherever possible and the care plans do reflect the current needs of the service users. Service users are offered the opportunity to participate in organised activities and social events, although some do choose not to do so. Staff also try to offer as stimulating an environment as possible for those residents in Cotswold unit who are unable to join group activities for any long period of time but do enjoy one to one chats and some musical events and exercises to music. 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. Horsfall House DS0000016476.V260421.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 Horsfall House DS0000016476.V260421.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): 1,3 The homes Statement of Purpose and Service Users Guide, although currently being updated, are excellent and provide service users and prospective service users with details of the services the home provides enabling an informed decision about admission, to be made. The admission process is well managed. EVIDENCE: Because of a number of managerial and other staff changes in recent months the Statement of Purpose and Service Users guide are currently being updated. Copies of the current documents were seen in reception and in service users rooms and they confirmed that they were fully aware of this information. There had been a number of new admissions since the last inspection. Most of these were seen and several spoken with, to include one relative and one gentleman on respite care. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 9 All were very happy with the facilities offered by Horsfall House and the care received and through observations and speaking with staff and residents or their relatives it was clear that their needs were fully understood by the staff and were all being met. Some records were seen and pre-admission and admission assessments had been completed. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 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): 7,8, 10,11 There is a satisfactory care planning system in place to adequately provide staff with the information they need to meet service users needs. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Personal support in this home is offered in such a way as to promote and protect service users’ privacy, dignity and independence. At the time of their death, service users and their families are treated with care, sensitivity and respect by the staff. EVIDENCE: A selection of care records from each unit was examined during the inspection. All have assessments from which needs are identified and care is planned, implemented and regularly reviewed with the resident or their relative where possible. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 11 Pressure sore and moving and handling assessments are also completed and reviewed monthly and where appropriate wound care charts implemented. A mixture of core and acute care plans are in use and all reflected the current needs of the service users. The care planning system did appear more consistent between the units on this occasion but is under constant review to find the best and easiest system to be used. Other documentation confirms good disciplinary working with reference to regular doctor’s visits, liaison with the wound care specialist and continence advisor, consultation with Macmillan nurses with particular reference to pain relief and visits from chiropodists, dentists and opticians which service users also confirmed. Where a resident had been noted as loosing weight, all are weighed monthly, a consultation was made by a dietician and food supplements initiated. Also, where residents had been identified at risk of pressure sores, pressurerelieving equipment was observed in place, to include a range of mattresses and cushions and a number of adjustable height (profiling) beds were in use. Some bed rails were observed in use and records confirmed that risks had been considered and relatives spoken with. However, the use of protective ‘bumper pads’ to cover these rails and prevent risk of any entrapment injury were not seen. The home later reported that they normally use protective pads or net-type rails but are also in the process of purchasing new beds that have smooth wooden frames incorporated into the bed frame, which should lessen any risks. Staff were observed going about their work in a calm and professional manner, addressing service users by their preferred form of address and knocking on doors prior to entering rooms. Residents and their relatives spoken with also confirmed that they are treated with respect at all times. During the inspection it was unfortunate that one service user had deteriorated and died early afternoon. It was observed that staff were very supportive of the relative during this period and dealt with the process with care, sensitivity and respect. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Social activities and meals are both well managed and provide some variation and interest for people living within the home. EVIDENCE: The home continues to offer as much stimulation for the service users as they can, taking into account that many of the residents on Cotswold Unit have very limited concentration spans and many on the General nursing unit are very private people and prefer to spend their days in their own rooms pursuing their own interests. A limited number of residents may join the day centre activities on a daily basis and some confirmed that they do so. One of the senior care staff on the general unit is also responsible with the help of her colleagues, for organising social events and an activities programme for the unit. A weekly exercise to music session is held on Cotswold Unit which most residents seem to enjoy and several on the General unit talked about the recent pantomime and carol service that had been held there. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 13 The residents have a varied and nutritious choice of meals offered each day and all confirmed that they enjoyed and looked forward to their meals. One relative spoken with in the general unit said that he joins his wife for meals each day, which he greatly appreciates. There were a number of residents on each unit who require assistance for meals and soft/pureed diets. One resident’ who was being assisted with her meal during the inspection would not eat her main course because it had not been pureed sufficiently. This was reported back to the catering staff. It was also noted that often all the food of the main meal appears to be pureed together which is not attractive to look at and does not offer the service user an attractive presentation or a variety of textures. The manager reported that she and the catering manager had just attended a training day to look at improved methods of presentation for pureed meals and this would be improved upon. The kitchen was observed briefly during evening meal preparation and appeared clean and well organised using the limited space effectively. The Environmental Health Officer last visited in March 2005 and no requirements were necessary for the kitchen. The current dining area next to the kitchen has limited space and is used mainly by the day centre clients with occasional residents who attend the day centre. There is a small dining area in one lounge on Cotswold unit where some residents choose to sit for their meals; others have individual tables in the other lounge. There are plans to join the two lounges in the near future increasing the lounge space and providing a larger communal dining area. There are also further plans to move and increase the size of the current kitchen and dining room on the ground floor. Provisional plans have been provided. On the general unit, although there is a small lounge and a dining room, few residents chose to use either, preferring to remain in their own rooms, although some are persuaded to eat in the dining room at weekends and some said they had been to the main dining room for Christmas lunch. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were looked at in this section on this occasion. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 15 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): EVIDENCE: No standards were looked at in this section on this occasion. However, the standards of décor, cleanliness and maintenance of the home continue to be very high. Horsfall House DS0000016476.V260421.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): 27,28,29,30 Staff are well trained and supported and employed in sufficient numbers to meet the residents needs. The procedures for the recruitment of staff are not sufficiently robust to totally safeguard the protection of the people living in the home. EVIDENCE: There were six care staff on-duty in each unit during the morning of inspection, in addition to a qualified nurse on each unit. This reduced to four care staff on each unit on the late shift but two qualified nurses remained. However, a change has been made to night cover with only one qualified nurse in the home but an increase from four to five care staff. This is to be reviewed constantly in line with the dependency levels and an additional qualified nurse would be allocated if it were felt necessary. The registered manager and unit managers are also on call and would go to the home if an emergency situation arose. It appeared that the numbers of staff meet the current needs of the service users and there were no negative comments from either staff or service users to state otherwise. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 17 60 of the care staff now has a National Vocational qualification at either level two or three and all spoken with were very enthusiastic about their training, which is run from Cirencester College. A list of all the staff trained, currently training or not yet commenced training was provided. Details of other planned training, such as an introduction to Palliative Care for care assistants, activities training and effective communication and interpersonal skills was discussed. A new Unit manager was appointed for the EMI Unit (Cotswold) in November 2005. She was not on-duty on the day of inspection. A new day care manager has also been appointed. A number of new staff has been appointed since the last inspection and all their files were checked at inspection. Although each person has a POVA First check and Criminal Records Bureau check before appointment, there were a number of gaps in the recruitment process noted: 1. All have completed an application form but some are poorly completed and do not give a full career history with dates when they commenced or left a job. A written record must be kept of any gaps in employment history and reasons for these. 2. Not everyone had a photograph. Some were poorly photocopied passport or driving licence photographs, which did not give a true likeness of the employee. 3. Not all had two written references and in some instances where two were given, there was not one from the last employer, which is especially pertinent when that person had held a care position previously. 4. Not all had a written record of the interview. 5. None of the qualified staff had a written confirmation/photocopy of the PIN registration with expiry date on their files. It was reported that these had been checked and an up to date record will be sent to CSCI to confirm this. All of the above documentation should be on file before the member of staff is appointed. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 18 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): 31,33, 38 There is good leadership, guidance and direction to staff from the cohesive management team at the home. This ensures residents receive consistent quality care and results in practice that promotes and safeguards the health, safety and welfare of the people using the service and the staff. EVIDENCE: Since the last inspection the registered manager has been formally approved by the CSCI and is now established in her position in the home. Residents and their visitors gave positive comments about the staff teams within the home and staff confirmed good supervision and communication systems are in place with regular meetings held for all grades of staff. A quality assurance programme is in place and satisfaction surveys were sent to the relatives of each resident and have since been collated with a copy of the results sent to CSCI. Most of the comments made in this survey were very positive and reflected the comments made at inspection. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 19 The home has someone employed to deal with any financial matters and she is responsible for all the invoices/payment of bills etc. The manager was unaware of any personal expenditure of the residents being held by the home, believing that generally the residents or their families took on these responsibilities. The financial administrator later confirmed this. The home has a health and safety policy in place but dated 2003 and signed by the previous manager. All the policies are currently under review and being updated. Ten staff have been selected to undertake a distance learning health and safety course and two staff will then be nominated as health and safety representatives for the home. No obvious risks were seen during inspection, other than unprotected bed rails in use. Records were in place to confirm that regular servicing and maintenance of equipment is carried out. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 20 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement All required documentation as identified in Schedule 4; Regulation 17(2) of the Care Homes Regulations be held in staff files. The registered person shall ensure that any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Timescale for action 28/02/06 2. OP38 13(2) 05/02/06 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. Refer to Standard OP15 Good Practice Recommendations Food, including liquefied meals, is presented in a manner which is attractive and appealing in terms of texture, flavour and appearance in order to maintain appetite and nutrition. Horsfall House DS0000016476.V260421.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Horsfall House DS0000016476.V260421.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. Re-publishing this information is in breach of the terms of use of that website. 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