Inspection on 11/07/05 for The Forbury

This inspection was carried out on 11th July 2005.

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

The Forbury 06/03/07

The Forbury 13/01/06

The Forbury 14/02/05

The Forbury 07/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE The Forbury Church Street Leominster Herefordshire HR6 8NQ Lead Inspector Denise Reynolds Announced 11 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Forbury Address Church Street Leominster Herefordshire HR6 8NQ 01567 613877 01568 612089 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr C A Lutton Ms L Millar Care Home 24 24 24 24 24 Category(ies) of Dementia - over 65 registration, with number Mental Disorder - over 65 of places Physical Disability -over 65 Old Age The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Due to the distance from the communal toilet on the first floor, bedrooms 8, 9, 10 and 11 not ot be used for people with restricted mobility until the planned ensuite facilities been provided in those rooms. Date of last inspection 7 September 2004 Brief Description of the Service: The Forbury provides a service to older people who have care needs arising simply due to their age or because they have particular needs due to physical disabilities, a dementia illness or other mental health difficulties.The building is a large Grade 1 listed Georgian house in the market town of Leominster. It is situated in a quiet street within walking distance of the town centre and the local church and park.~ ~ An extensive refurbishment project has been underway for 3 years resulting in more single rooms, ensuite facilities and communal space. The kitchen has been upgraded and a salon quality hairdressing room is nearing completion. Remaining work is expected to be finished during 2005 and includes the addition of 4 more single rooms allowing a further reduction in the number of shared rooms; provision of a conservatory and works to the garden and driveway. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Monday and lasted from just after breakfast until early evening. The inspection was announced to ensure the presence of the manager and provider. This was necessary to follow up some things from the previous report and to review progress on the upgrading of the premises. Comment cards were sent to health and social care professionals by CSCI and provided for the Home to give to relatives, residents and staff. There was a reasonably good response with replies received from five residents, three social workers, four GP practices, eight relatives and seven staff. Comments were also received from a visiting hairdresser, a chirpodist and from an activity organiser. During the inspection 3 residents were spoken to individually as were the manager, deputy manager and Provider. Staff were asked to encourage colleagues to fill in and return the staff questionnaires in the pre paid envelopes provided. A sample of records including care records and staff records were looked at. More time than usual was spent looking around the building, this was to see what work had been completed and what was still being done. Observations made throughout the visit contributed to the overall impression of what life at the home is like from the residents’ point of view. What the service does well: Staff are very attentive to the physical care needs of residents and treat them with dignity and respect. Comments received through consultation included – “This is a happy family Home. All staff are compassionate, thoughtful, kind and helpful.” “The Forbury has a homely feel all the time.” “I am very impressed with the standard of care they offer ……………” “The Forbury takes very good care of its residents. It is a pleasure to visit and to see residents mobile, involved and talked to by the staff.” “The manager has fostered very good relationships with her staff. Her attitude to the needs of residents appears paramount, they are treated with dignity and love!” The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 6 One GP wrote ‘ Excellent, careful and caring care team’. The premises have been subject to considerable investment in recent years and upgrading is still underway. The standard of work and the overall improvement to the accommodation and facilities reflects the Provider’s commitment to the Home. 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. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 standard(s) 3 The information gathered by the Home before a person arrives is sufficient to ensure that they know what help they need and that the Home can provide this. This increases the likelihood of a move to the Home being successful. EVIDENCE: Social services department assessments are in place for funded residents and there is an assessment format that the Home uses for all prospective residents whether funded by a local authority or self funded. The information looked at for 2 people who had most recently moved in contained good basic information and this had been used to form the basis of the ongoing care plan. Excellent daily records were seen for the first few days of one person’s stay at the Home – these showed that staff were building a picture of the person and passing on information to inform other staff. A requirement made in the last report was therefore met. One of the assessments looked at would have benefited from more information to explain why the person had needed to move to the Home. This is an area to develop to help staff support new residents during their first few days when they may be anxious and wondering if they have made the right decision. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 9 When spoken to both people said that staff had made them very welcome when they arrived and that they were very satisfied with their care. One said, “I didn’t want to come and now I wouldn’t want to go!” The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Staff are conscientious in observing residents changing needs and acting on them ensuring that people living at the Home receive the care and attention they need. The current content of care plans provides a good level of basic information which staff can now build on to assist them in providing a good quality of care. Medication arrangements reflect good practice and provide a sound framework for the safe administration of medication. EVIDENCE: The content of the care plans has improved since the last inspection. The daily records in particular provide a good picture of the care needed and provided. These are now being written in individual care files rather than in a communal book as before; a requirement regarding this has therefore been met. There was evidence that the Home has begun to involve residents more in the content of their plan of care – for example it was recorded that one person did not wish to provide information for the ‘past history’ section of her care plan. There is still scope for developing the information in the care plans, for example by using information about previous pastimes to give staff ideas for how people might enjoy spending their time now. Some topics – e.g. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 11 mouthcare need to include more specific information than is included at the moment. A contradiction regarding the use of the call bell system was noted. One resident had been told not to hesitate to use the bell for whatever they needed while another had been told that it should only be used for emergencies. It is important for all staff to have a shared understanding of the reasons residents can use the call bell. Situations where residents use it inappropriately to the detriment of other residents should be carefully monitored and discussed with the person and where appropriate, their relatives. Decisions about how staff should deal with such situations must be clearly recorded in the person’s care plan. It reflects well on the attentiveness of staff that no residents have pressure area damage at present. Residents’ weights are closely monitored and it was noted that a resident with a low weight on admission had begun to gain weight. There were 2 people being cared for in bed but only 1 slide sheet available; slide sheets should only be used for one person to avoid risk of cross infection and enough need to be available to allow for laundering. Since the inspection the manager has confirmed that more have been ordered. Moving and handling assessments are kept in a plastic sleeve in each person’s care file. It would be helpful for the pages to be arranged so that the whole assessment can be seen. Feedback from general Practitioners, social worker and relatives portrayed confidence in the care provided. Care records and observation during the inspection supported this view. The deputy manager has worked very hard to improve the arrangements for the management and administration of medication in the Home and has met all the requirements and recommendations made in the previous report. The situation of the medication cupboard in the dining room, though convenient, detracts from the homely feel of the room and takes up a lot of space. Throughout the inspection staff were observed to be respectful and caring towards residents and residents spoken to were appreciative of the staff. Comments received through the consultation process reinforced this positive view and have been reflected in the summary of the report. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 standard(s) 13 The Forbury staff help residents keep in touch with relatives and friends by making it a relaxed and welcoming place for people to visit. EVIDENCE: Entries in the visitors book showed numerous visitors and comment cards from relatives and other visitors and discussion with residents confirmed that visitors are made welcome. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 standard(s) these standards were not inspected during this inspection. EVIDENCE: The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 standard(s) 19. 20, 21, 22, 23, 24, 25, 26 Overall the accommodation is of a very good standard. Attention to the areas identified in this report, together with the ongoing improvements to the premises will ensure that residents will be able to enjoy living in comfortable, well-appointed and safe surroundings in the years to come. EVIDENCE: The ongoing refurbishment and extension of the accommodation is being done to a high standard and in full consultation with all the relevant regulatory bodies. The amount of communal space was increased by the addition of a new dining room 3 years ago. A conservatory and small seating areas are planned as part of the extension currently under construction. Access to the garden will be improved as part of this work which includes the creation of a paved courtyard and improvements to the vehicular access. When this is finished residents will be able to get into the new courtyard and the flower gardens without having to The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 15 cross the drive. Rebuilding of the front wall and renovation of the front garden are also planned. The provision of a salon standard hairdressing room is nearing completion. One element of the upgrading has been the provision of ensuite toilets in all but 2 bedrooms. The next phase of work includes the refurbishment of the bathrooms and sluice facilities. It is important that authoritative guidance be sought regarding best practice in relation to layout and equipment for these rooms to ensure the best outcome is achieved. Residents’ bedrooms are well maintained and decorated and furnished to a very good standard. Rooms are spacious and people are encouraged to personalise them with their own belongings. Low surface temperature radiators have been fitted throughout the house. The installation of a radio operated call bell system and staff pagers means that residents don’t have to put up with the noise of calls bells sounding. The house was clean and generally tidy. Staff coats and bags were placed in one corner of the dining room which limits the security for staff belongings and creates a tripping hazard. Similarly, some records are kept on the dresser in this room and make the room look cluttered and untidy. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Staff at the Home are hardworking and conscientious and provide residents with a good standard of care. The manager needs to have written confirmation at the Home regarding the outcome of CRB checks so that she can satisfy herself regarding the suitability of staff she employs. Planned increases in ancilliary staffing should further improve overall standards. EVIDENCE: The manager confirmed that staff do not start work at the Home without CRB and POVA first checks being received and that staff currently at the Home have all had a CRB check done. There was one exception to this in respect of one staff member who started at the Home in March 2005 – the Manager had been unable to obtain confirmation that a CRB certificate had been received. Documentary information about POVA and CRB checks is kept by the Provider at his business address. A record confirming these checks must be kept at the Home. The manager is working on a format for staff interviews to ensure they are appropriately structured and cover all the necessary areas such as asking about gaps in employment and reasons for leaving previous posts. A small number of staff and relatives indicated that they do not feel that there are always sufficient staff on duty. The manager explained that cover for sickness and holidays has been a problem at times but that the situation has stabilised and that usually there are 3 staff on throughout the day and 2 staff awake at night. Staff rotas for July confirm this level of staff cover. The manager’s hours are normally in addition to this although if needed she does The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 17 cover shifts. Plans were in hand to have a part time laundry assistant with the possibility of this becoming full time if successful. Consideration is also being given to appointing another cleaner. Both these initiatives would have a positive impact on the availability of care staff to fulfil their main role of caring for the residents. A rolling training programme to keep staff up to date in core health and safety related topics such as first aid, fire safety and moving and handling is ongoing. A pre printed workbook has been introduced to support staff induction training linked to Skills for Care national occupational standards. All the feedback received through consultation with residents and others gave a positive picture of the staff team. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Overall attention to health and safety is good; building in additional safeguards will prevent the possibility of oversights resulting in the risk of harm to residents or staff. EVIDENCE: A sluice room and storeroom were both unlocked presenting a risk to residents from unsecured cleaning products and tools. It had gone unnoticed that window restrictors on some first floor windows were missing or broken. It was confirmed that matters detailed in a report from Herefordshire Council Environmental Health Department following an inspection in February have all been dealt with. Information about the action taken was not sent to the Commission as required in the previous report. It was confirmed that maintenance procedures are in place to protect against the risk from legionella. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 19 Arrangements have been made to look at the way final exit doors are secured when a fire safety specialist visits the Home on 19th July. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 13 Requirement The Commision must be informed of the outcome of discussions regarding how final exit doors are secured.(Timescale for previous requirement not met) Documentary confirmation that POVA and CRB checks have been for all staff must be kept at the and be available for inspection. A lock must be fitted to the door of the sluice room to eliminate risk to residents from cleaning products.(Immediate requirement) A lock must be fitted to the door of the storage cupboard under the eaves to eliminate risk to residents of falling.(Immediate requirement) Carry out risk assessments for unrestricted first and second floor windows and fit restrctors as required.(Immediate requirement) The registered persons must inform CSCI in writing of the actions taken in response to the Environmental Health Officers report. (Timescale for previous requirement not met) E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Timescale for action 31st August 2005 2. 29 19 31st August 2005 12th July 2005 3. 38 13 4. 38 13 15th July 2005 5. 38 13 31st August 2005 6. 38 13 The Forbury Version 1.30 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 3 7 7 7 9 19 Good Practice Recommendations Staff should continue to develop the content of assessment information as descirbed in the report. Staff should continue to develop the content of care plans as described in the report. Continued efforts should be made to involve residents in contributing to the content of their care plans. The moving and handling assessments need to be filed so that each page can be looked at easily. Consideration should be given to re-siting the medication cabinet. Storage arrangements for records and staff belongings should be improved. The Forbury E52 - E02 S24735 The Forbury V234450 110705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN 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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