Inspection on 21/03/08 for The Foam

This inspection was carried out on 21st March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Foam 20/02/09

The Foam 06/07/06

The Foam 18/01/06

The Foam 01/09/05

The Foam 08/02/05

The Foam 31/08/04

The Foam 24/02/04

The Foam 31/01/03

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Foam Chapel Road Dymchurch Romney Marsh Kent TN29 0TD Lead Inspector Sarah Montgomery Unannounced Inspection 21st March 2008 14:30 The Foam DS0000023232.V359484.R01.S.doc Version 5.2 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 The Foam DS0000023232.V359484.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 Adults 18-65. 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. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Foam Address Chapel Road Dymchurch Romney Marsh Kent TN29 0TD 01303 875151 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) www.craegmoor.co.uk Parkcare Homes Ltd vacant post Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection Brief Description of the Service: The Foam is registered as a Care home providing 24 hour care and support for up to three people with a learning disability. Craegmoor Healthcare (ParkCare Homes no 2) is the registered provider. The home does not have a registered manager at present. The home is a detached bungalow in a residential area of Dymchurch. The accommodation comprises of three bedrooms, a lounge /diner, kitchen, and bathroom. There is a small office which doubles as a staff sleep in room. Weekly charges range between £905 and £1195.88. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery conducted this unannounced inspection on 21st March 2008. All key standards were inspected. There were some areas where the home is working well, particularly in the area of care planning and supporting residents with their lifestyle choices. Some shortfalls were identified. Of particular concern was the lack of a registered manager, and the poor condition of the home, both in physical terms and the state of cleanliness. Full feedback was given on the day to an area manager. The quality rating for this service is *one star adequate service. What the service does well: What has improved since the last inspection? What they could do better: The home would benefit from upgrading fittings and furnishings, as well as redecoration throughout. A formal cleaning schedule for all areas of the house and garden would ensure that residents live in a clean and hygienic environment. Improvements to individual residents files would ensure that information was stored correctly, and could be accessed easily. Improvements to the home’s recruitment files would ensure the home could evidence a robust procedure which safeguards residents. Residents and staff would benefit if a registered manager was recruited. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is adequate. Prospective service users cannot be sure their individual needs and aspirations will be appropriately assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents live at the home. Both files were inspected, with particular attention given to pre assessment, review, care planning and risk assessment. It was clear that sufficient time and effort had not been spent ensuring resident’s files were in order or that they contained the correct information. Both files were in a mess, and the order of documents was haphazard. On one file assessment documentation could not be found, although the staff member assured the inspector it was in the home. One pre assessment was inspected. This demonstrated that some consideration had been given to assessing the individual prior to admission with regard to meeting assessed needs. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 9 It is accepted that both residents at the home have lived there for a considerable amount of time. The pre assessment inspected did reflect this, and no consideration was given in the pre assessment regarding the resident’s wishes or aspirations. There is one vacancy at the home. Prior to filling this vacancy, it is recommended that the home update their pre admission assessment documentation. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 9 and 10. Quality in this outcome area is good. Residents benefit from having clear care plans which document their individual needs and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both care plans were inspected. It was evident from reading the care plans, talking to a resident, and with staff, that the care plans reflect the individual needs and choices of residents, and also reflect personal wishes and aspirations. Care plans based around independent living skills would benefit residents more if information was recorded with regard to how individual residents are supported, and what specifically the support needs are. Care planning for independence also requires a goal orientated approach. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 11 Risk assessments are in place but require improving. All risk assessments read lacked sufficient detail to be considered effective. The home needs to ensure that risk assessments contain key information about the risk and support needs. Risk assessments should not just say ‘see care plan’, but should be a stand-alone document designed to enhance an individuals life with tailor made support. Inspection of daily records, coupled with conversation with a resident and a relative, clearly evidences that residents are supported and encouraged to make decisions and shape their lifestyle choices in accordance to their wishes. Observation of interactions between staff and residents during the inspection demonstrated that staff have in-depth knowledge of the needs and wishes of residents, and will consult with residents, and seek their opinions as a matter of course throughout the day. As stated in the previous outcome group, resident’s files are not organised appropriately, and information is not stored correctly. The home must address this as a matter of urgency. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Residents are supported to make positive lifestyle choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both residents have weekly activity planners. These planners reflect the needs and wishes of residents, and the level of activity described on the planner is based on clear guidance from residents about how they want to live their lives, and what they prefer to do on a day-to-day basis. Weekly planners were cross-referenced with daily records and with care plans and risk assessments. The staff team and a resident were also spoken with regarding lifestyle choices and how these are supported on a daily basis. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 13 The evidence gathered demonstrated that residents have an individual service based on their assessed needs, choices and aspirations. Residents have daily opportunities to participate in the local community, and to take part in activities both in house and community based which they chose and enjoy. Residents are fully supported to maintain contact with important people in their lives. During the inspection one resident had gone away for the weekend to visit family, and the remaining resident had a family member visiting. On the day of inspection a weekly shop was completed. The food was inspected and found to be of good quality with plenty of fresh fruit, fresh vegetables and a variety of meats. A resident spoke highly of the food prepared, and the staff demonstrated knowledge regarding the known likes of residents balanced with ensuring residents are offered healthy food choices. However, concern was raised over the cleanliness of the home, including the fridge and freezer storage facilities. While it is accepted that the home is currently having a new kitchen fitted, the home must ensure that they have taken all possible steps to ensure the health and welfare of resident is protected at all times. This was not the case, and will be discussed in more detail in the environment section of this report. The home has two freezers. These are kept in the garage. Both freezers were very dusty and dirty on the outside. When the small freezer was opened, an unpleasant odour came from it. Inside it was completely iced up, and requires defrosting and cleaning. There were several opened packets of food, none were labelled. Two ice cream containers were without lids. The larger freezer was the same; iced up, unpleasant odours and opened food packets not labelled. The fridge was inspected. Its internal surfaces were dirty. There was open food in the fridge, which had not been labelled. The deep fat fryer in the kitchen had rancid fat in it. Cutting boards were on the floor, and the bin was without a lid. The staff were advised to address the conditions of the fridge and freezers immediately, this involved disposing of unlabelled food, cleaning the fridge, defrosting the freezers, and ensuring they were clean inside and out. In addition, the home was advised that they may need to purchase a new fridge to ensure food is kept at correct temperatures. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 and 19. Quality in this outcome area is good. Residents can be confident they will be supported with their personal and healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Health care plans, including mental health care plans were in place for residents. The manner in which these plans are written demonstrate that staff clearly recognise that the delivery of personal care is very individual and must be consistent with the wishes of the individual resident. Health care plans were descriptive and specific about how the resident preferred and wanted to receive personal support. Care plans were written in a way that upheld the dignity of the individual. Information recorded in mental health care plans evidenced the home seeks support and guidance from mental health professionals, ensuring that individual residents have access to a range of health care professionals should they require it. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is adequate. Residents views are listened to, but they would benefit from having an accessible complaints procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector had a discussion with a resident about making complaints. It was clear from this discussion that the resident felt able to express his views and knew who to talk to. However, the staff could not find the home’s complaints procedure, and it was not displayed in the home. All residents need to have access to a complaints procedure and the home must ensure that it is displayed in a communal area. Staff have received safeguarding adults training. Discussion with staff on duty evidenced a sufficient knowledge of safeguarding issues, but the home and residents would benefit from having a full time manager in post to ensure all policies and work practice were in line with safeguarding protocols. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26 and 30. Quality in this outcome area is poor. Residents are at risk from harm due to living in a hazardous and unhygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector arrived at the home at 2.30 in the afternoon. One resident was at home; the other resident was away for the weekend. Two members of staff were on duty. The resident at the home was in his room, and the inspector understands it is his general preference to spend most of his time in his room. The home’s front door opens onto the lounge. Three dogs were in the lounge. These dogs belong to a member of staff, and it is the inspectors understanding that the residents of the home, and the Company, who own and manage the home, are happy for the dogs to be in the house. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 17 The lounge was very dirty. The carpet was covered in dog hairs to an extent that it was clear they had become intertwined with the carpet. As well as dog hairs, the carpet was strewn with debris, dirt and dust. This amount of dirt could only have built up over an extended period of time. The furniture was also covered in dog hairs, and there was no surface that could be considered clean. The windows were dirty inside and out. Plants hang from walls and ceilings. Furniture does not match (a bedside cabinet with a plant on), and the walls are dirty and stained. A large lamp is balanced precariously on the edge of a dining table. A staff member stated that he had hovered in the lounge that morning, and could not see a problem with the state of hygiene. This raised more concern with the inspector, as it is less likely improvements will be made if there is no understanding of the problem. A tour of the home evidenced further breaches in health and safety. All windows in the home were very dirty, the bathroom (which is due to be renewed) has a foul damp smell. Both sink taps do not turn off, paint is peeling off tiles, there is ground in dirt on the floor, flooring is ripped by the toilet and bath, a dead plant is hanging above the bath, and tiles are missing behind the toilet. The office/sleep in room was filthy. Cobwebs hung from the walls. The carpets were dirty and covered in dog hairs. The garden is completely hazardous. It is full of broken furniture, broken fences and discarded bins. The large garage is also a store for old and broken furniture. The garage was open, and cleaning material was left out. The COSHH cupboard, which is stored in the garage, was open with the key left in the lock. Bedrooms require redecorating. In particular, the bedroom of the service user who prefers to stay in his room requires all new furniture and fittings, as well as a new chair. The physical state of this home is completely unacceptable. Even considering a new kitchen is being fitted; it should not mean that the entire home is filthy. The home is required to contact environmental health to arrange for a consultation visit. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is adequate. Residents would benefit from a more robust recruitment practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A small staff team support the residents at this home. The Foam is one of several Craegmoor homes in the area, and staff benefit from receiving support from other homes, as well as having ample opportunities for training. Records viewed evidenced regular training in key areas. This includes adult protection training. Observation on the day of inspection evidenced good relationships between staff and residents. Staff clearly had skills in communicating well, as well as a sound knowledge of the needs of the residents. Shortfalls were identified in the home’s recruitment processes. While it is accepted that most staff were recruited when a different provider owned the The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 19 home, it is the current providers responsibility to ensure all files, policies and procedures in the home comply with current Standards and Regulations. The home is advised to review their staff files. Although the inspection evidenced that residents receive good support from staff, the poor state of the environment raises concerns regarding staff awareness of the physical environment. Resident’s health and welfare is compromised by the poor conditions of the home. Staff must be more aware of these issues, and must ensure that the house is clean, hygienic and hazard free. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 and 42. Quality in this outcome area is poor. Residents cannot be confident they live in a well run home and would benefit from the home having a full time registered manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home does not have a manager. Evidence gathered during the inspection demonstrates that this has been detrimental to the running of the home; resident files and staff files have significant shortfalls; the physical environment is run down; and policies are either missing or cannot be found. It is imperative that the Company recruit a registered manager as a matter of urgency so that these shortfalls can be addressed, both in the short term and long term. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 1 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 1 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 1 X x X X 1 x The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA30 Regulation 16(2)(g) Requirement The registered person shall ensure that freezers and fridges are clean, defrosted, in good working order, with all food correctly stored, covered and labelled, and that the equipment operates at the correct temperature. The registered person must ensure that the home has a complaints procedure, and that this procedure is supplied to all residents. The registered person must ensure that the home is clean and hygienic, and that satisfactory standards of cleanliness are maintained. The registered person must consult with the environmental health department concerning the physical environment. The home must send all copies of this correspondence to CSCI. The registered person must ensure that the garden and outbuildings are safe for use by residents, with all hazards being removed, and that this environment is appropriately. DS0000023232.V359484.R01.S.doc Timescale for action 22/03/08 2. YA22 22 30/04/08 3. YA24 16(2)(j) 22/03/08 4. YA24 16(2)(j) 30/04/08 5 YA24 23(2)(o) 30/04/08 The Foam Version 5.2 Page 23 6. YA38 8(1)(a) The registered provider shall appoint an individual to manage the care home. 30/05/08 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 YA2 YA10 YA9 YA34 Good Practice Recommendations Pre assessment documentation should be reviewed and updated. The home must ensure that resident’s files are organised appropriately with all information being stored correctly. Risk assessments must contain sufficient information regarding the identified risk and subsequent support needs. It is recommended that the home review staff files. The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 The Foam DS0000023232.V359484.R01.S.doc Version 5.2 Page 25 - 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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