Inspection on 13/01/06 for The Forbury

This inspection was carried out on 13th January 2006.

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 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

The Forbury 06/03/07

The Forbury 11/07/05

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 Forbury The Church Street Leominster Herefordshire HR6 8NQ Lead Inspector Sarah das Neves Pedro Unannounced Inspection 13th January 2006 11:00 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 Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Forbury The Address Church Street Leominster Herefordshire HR6 8NQ 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) 01568 613877 01568 612089 Mr Christopher Anthony Lutton Ms Louise Millar Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24), Physical disability over 65 years of age (24) Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2005 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. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? The building work continues and the improved facilities will be a significant improvement to an already comfortable environment. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 7 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. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 8 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 Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 9 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): These standards were not assessed at this inspection but were found to be satisfactory at previous visits. This home does not offer Intermediate Care so this standard does not apply. EVIDENCE: Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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, and 10 The overall improvements to the care plans have been maintained. They allow sufficient information to be obtained to ensure that all aspects of residents care can be addressed; two of three care plans selected had been updated and were satisfactory. People living at the home are treated with care and respect and dignity and privacy are central to the ethos of the home; but the absence of screening in shared rooms severely compromises the privacy and dignity of the occupants and the presence of continence protection pads on all chairs give an initially poor impression of the home. The visiting Community Nurse confirmed that care standards in the home were very good. EVIDENCE: Three care plans were selected at random. A full range of assessments had been completed for two of the residents ensuring that all care needs could be met and instructions carried out. The third plan had not been fully updated, the dietary advice being inaccurate and potentially hazardous if followed. Staff knowledge was current and complete but this should be reflected in all written care plans. In the previous report, Good Practice Recommendations were made in regard to Care Planning; they are therefore re-iterated in connection to this inspection. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 11 Further information was available for three residents who were under the care of the Community Nursing Service. Two were being cared for in bed because of deterioration in their condition and a third was having dressings to ulcers on her legs. The Inspector spoke at length to the Community Nurse who was visiting the home at the time of the inspection. He confirmed that • he was satisfied with care standards in the home • instructions regarding care were carried out appropriately • residents were well cared for • advice was acted on. An example of this and observed good practice was that all staff carry their own alcohol hand cleaner. He had recorded in the records of one resident that she “appears well cared for” and that her pressure areas had been checked and were intact. His only criticism of the home was that paper hand towels were not available in all areas. Staff were observed being kind and respectful of residents and using their preferred form of address and residents confirmed that this was usual, it was disappointing therefore to see that the majority of seating in the days areas had been covered with continence protection pads. This was discussed with the owner who was advised that if this protection was required for assessed individuals it should be done discreetly. Similar issues of dignity were discussed with regard to the absence of screens in shared rooms; it was also confirmed that screens were not available if residents wished to use the commode in these rooms. A low score has been given to this section for these reasons only and does not reflect the general attitude of the management or staff at the home who were without exception kind and considerate towards the residents. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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): 14 and 15 Residents are listened to and have choices about where they spend their time. Residents rooms were well personalised containing many pieces of the residents furniture, photographs and mementoes of their life before entering The Forbury. The quality of the food provided is satisfactory and the kitchen facilities are clean and modern. Residents nutritional needs are assessed and requirements met. EVIDENCE: Many of the residents at The Forbury are unable to fully express their opinions but the rooms seen during the inspection contained many personal items reflecting the character and previous life of the occupant. Residents spend their time where they wish and are not restricted within the home. The lunch seen served was attractively presented and well cooked. Residents have a choice of meal and a resident informed the Inspector that if she did not like the menu options, the cook would always provide an alternative. Residents eat their meals in small social groups in the dining or their own rooms as they wish. The kitchen was clean and tidy and fit for purpose and staff were knowledgeable about the dietary requirements of the residents. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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): These standards were not fully assessed at this inspection, however the response and co-operation of the homeowner in regard to a recent complaint to the Commission was satisfactory. The investigation is ongoing. EVIDENCE: Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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, 20, 21, 23, 24, 25 and 26 The standard of the accommodation is generally good, however there are some areas that require urgent review; these include the number of baths and the sluice. Work is also required to improve a fire exit and fire exit signage. The building work at The Forbury continues and the following comments are made in the knowledge that the home is undergoing major changes. The owner has stated his commitment to creating a comfortable, wellappointed home for the residents to enjoy EVIDENCE: The inspection of the premises included all public areas, sanitary facilities, the kitchen, five bedrooms selected at random which included unoccupied and occupied rooms and single and shared rooms and the areas still under construction. It was disappointing to note that the hairdressing room had not yet been completed despite being nearly finished at the previous inspection in July. Groups of residents were spoken to during the inspection and while they were eating lunch. One of the more able residents was interviewed privately while she was enjoying her pre lunch sherry. She gave a lively and complimentary Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 15 view of life in the home and confirmed that she was happy with standards there. The inspector was accompanied by the senior carer on duty and was later joined by the owners son and the owner. The house was generally clean, tidy and appropriately furnished. Residents’ rooms are spacious and well personalised as residents are encouraged to bring their own belongings to create a homely and familiar environment. The planned outside features, additional bedrooms and dining room space will improve the already comfortable accommodation. In addition to the refurbishment and extension, the owner is continuing with routine upgrading and redecoration. It should be noted that in view of the work intended to be undertaken, not all areas identified below will be subject to requirements; however, the following points require urgent attention: • The damaged carpet and ensuite floor covering in the room identified must be replaced, as should the WC plinth. • The surface temperature of some radiators were excessively hot, they must be covered or replaced • Because of damage to the roof and subsequent damage to the ceiling of the second floor bathroom, the home currently has only one bathroom; this is not sufficient to meet the needs of the number of residents in the home and must be increased. • On examination the underside of the hoist in the bathroom was found to be dirty. Staff must ensure that all surfaces of the hoist are clean and fit for residents use • The sluice is now kept locked but was found to be used as a temporary store for miscellaneous items. These should be removed and the area reviewed to create a usable sluice. • The wall in the shared room is cracked and requires repair • From the previous inspection, risk assessments must be carried out with regard to unrestricted windows on the upper floors. These matters were discussed with the owner who had already included many of the issues in his overall plans. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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 These standards were not fully assessed but improvements were noted at the last inspection and were generally satisfactory. EVIDENCE: The number of staff on duty on the day of inspection were a senior carer, 2 care assistants a cleaner and a cook. In addition, the owner’s son was supervising the builders and the owner attended the home after lunch. The staff appeared to be unhurried and able to spend time with residents. The numbers of staff was appropriate at the time of inspection. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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): 32 and 38 These standards were not fully assessed but health and safety issues, the fire exits and infection control measures were considered during the premises inspection. Further information relevant to this section can be found in the section on the Environment. Risk assessments had not been carried out and restrictors had not been applied to second floor windows. This had been subject to an Immediate Requirement at the previous inspection. The atmosphere in the home is open, positive and inclusive. EVIDENCE: Windows in a second floor bedroom were found to be fully opening. The occupant expressed her concern and asked that they should not be restricted in any way but the home was unable to provide a risk assessment regarding this situation. These risk assessments had been an Immediate Requirement at the last inspection and must now be completed as a matter of urgency. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 18 Repairs to a fire exit corridor from a bedroom had not been completed and would be hazardous if it had to be used in an emergency, the temporary fire exit signs must be replaced with approved signage. Throughout the inspection, it was noted that the staff were open, helpful and keen to assist. The staff, owners and management were knowledgeable and approachable; the residents confirmed this. They were receptive to comments and suggestions and open in their responses. Staff were seen treating residents affectionately but politely and with respect, the atmosphere throughout the home was calm and relaxed. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 3 1 X 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X 2 Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 20 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 OP19 Regulation 13 Requirement The Commission must be informed of the outcome of discussions regarding how final exit doors are secured. (Timescale for previous requirement not met). NOT ASSESSED AT THIS INSPECTION Documentary confirmation that POVA and CRB checks have been completed for all staff, must be kept at the home and be available for inspection. NOT ASSESSED AT THIS INSPECTION A lock must be fitted to the door of the storage cupboard under the eaves to eliminate risk to residents of falling. (Immediate requirement) NOT ASSESSED AT THIS INSPECTION Carry out risk assessments for unrestricted first and second floor windows and fit restrictors as required. (Immediate requirement). NOT COMPLIED, TIMESCALE EXTENDED The registered persons must inform CSCI in writing of the actions taken in response to the Environmental Health Officers DS0000024735.V278149.R01.S.doc Timescale for action 28/02/06 2. OP29 19 28/02/06 3. OP38 13 28/02/06 4. OP38 13 28/02/06 5. OP38 13 28/02/06 Forbury The Version 5.1 Page 21 6. OP38 13 7. OP10 12(4), 16(2) report. (Timescale for previous requirement not met) NOT ASSESSED AT THIS INSPECTION The registered persons must 28/02/06 inform CSCI in writing of the actions taken in response to the Environmental Health Officers report. (Timescale for previous requirement not met) NOT ASSESSED AT THIS INSPECTION The arrangements for health and 28/02/06 personal care ensure that service users’ privacy and dignity are respected at all times, and with particular regard to: personal care giving, including, bathing, washing, using the toilet or commode, entering bedrooms, toilets and bathrooms. • Screens must be provided in shared bedrooms to ensure the privacy and dignity of residents • If continence protection is needed it should be provided discreetly on an individually assessed basis. Toilet, washing and bathing facilities are provided to meet the needs of service users. • The number of usable bathrooms must be increased • The bath hoist must be clean and fit for use. The heating of service users’ accommodation must meet the relevant environmental health and safety requirements. • Those radiators that are not low surface temperature must be covered or replaced. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and DS0000024735.V278149.R01.S.doc 8. OP21 23(2) 28/02/06 9. OP25 23(2) 28/02/06 10. OP19OP38 23(4) 28/02/06 Forbury The Version 5.1 Page 22 staff. • Repair must be effected to the fire exit corridor identified • The fire door signage must comply with the relevant fire safety Regulations 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. Refer to Standard OP3 OP7 OP7 OP7 OP9 OP19 Good Practice Recommendations Staff should continue to develop the content of assessment information as described in the report. NOT ASSESSED AT THIS INSPECTION 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. NOT ASSESSED AT THIS INSPECTION The moving and handling assessments need to be filed so that each page can be looked at easily. NOT ASSESSED AT THIS INSPECTION Consideration should be given to re-siting the medication cabinet. Will be reviewed when the extension has been completed. Storage arrangements for records and staff belongings should be improved. Will be reviewed when the extension has been completed. Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire 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. Extracts may not be used or reproduced without the express permission of CSCI Forbury The DS0000024735.V278149.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!