Inspection on 12/02/07 for The Foxwalls

This inspection was carried out on 12th February 2007.

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

The Foxwalls 11/06/07

The Foxwalls 03/01/06

The Foxwalls 09/08/05

The Foxwalls 08/03/05

The Foxwalls 20/09/04

The Foxwalls 05/03/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Foxwalls Marston Road Stafford Staffordshire ST16 3BU Lead Inspector Mrs Wendy Grainger Key Unannounced Inspection 13 February 2007 09:00 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 The Foxwalls DS0000035821.V326956.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 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 Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Foxwalls Address Marston Road Stafford Staffordshire ST16 3BU 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) 01785 277088 Staffordshire County Council, Social Care and Health Directorate Bridget Hill Care Home 48 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (32), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (12), Old age, not falling within any other category (7), Physical disability over 65 years of age (16) The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. (DE) - 3 Both sexes - Minimum age 50 years on admission Date of last inspection Brief Description of the Service: The Foxwalls is a purpose built Local Authority home that was registered for 39 older people. The home had being extensively altered and was now registered for 48 older people. The home is owned by Staffordshire County Council and operated by Staffordshire Social Services. The home is located in a residential area of Stafford and is close to amenities and served by public transport. The home is pleasantly situated with lawns, a quadrangle and external sitting area. Adequate car parking, external roadways and pathways are provided. The accommodation is provided on one floor and comprises single bedrooms and all necessary facilities. Services and facilities including laundry, catering and hotel services have been adequately maintained, with adequate staffing levels. Activities, hobbies and entertainment all take place and transport is provided when required. Families and friends are encouraged to take part in activities and trips out. Care is provided by teams of care assistants each having a care shift leader. They are responsible to a care team leader (deputy manager) and the home manager. Health service professionals such as district nurse, community psychiatric nurse, and physiotherapist are accessed when required and local GPs and a pharmacist service the home. From the information provided in the pre inspection questionnaire the current fees for the home were £365. Additional costs would include hairdressing, private chiropody, personal toiletries and newspapers. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was completed on the 13th February 2007, the inspector was assisted initially by the Care Shift Leader, then the Registered Care Manager when her late duty commenced. Records, reports, documents were made readily available during the day. A tour of the home, speaking to staff, visitors and residents will be included in the report. The inspector was provided with a pre inspection report prepared by the registered care manager, the three resident comment cards returned to the commission will be part of the report. Staff during the inspection were observed to be aware of individuals needs and responded accordingly. What the service does well: Residents told the inspector that they were satisfied with the care they received “they are good you know and are there if I need them” The Foxwalls provides a comfortable well-maintained environment; fixtures and fittings were of a good quality. Staff were respectful and assisted residents in their chosen daily routine. The on going training for the staff enables them to provide quality care. Menus were based on home cooking, prepared fresh on a daily basis. The registered care manager leads by example, she had a relaxed style of management. Comments from relatives include “ we could not find a better home for my mother, she is happy and the staff are very good and patient with her” “Foxwalls is a comfortable, clean and well run home” “My mother is well cared and loved by the staff, I could not wish for anything better”. Each of the comment cards evidenced confirmed that the relatives had seen no cause to raise a complaint. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The inspector had concerns regarding the medication system and the nonsigning for medication administered. The small sample of care plans evidenced that the plans were devoid of a current residents photograph. There were inconsistencies in the contents in respect for the review of risk assessments. The management need to review and consider expanding the risk assessment to include all the potential risks undertaken by the residents. The activity person needs to ensure that she includes in her activity programme the residents who were less able in the large front lounge. There was no evidence collectively to identify any activities provided. One resident told the inspector that she “was bored all of these go to sleep and there is nothing to do” The cook on duty at the time of the inspection did not present the liquidised meal in an attractive manner. The meal was served as a brown mixture in a dish. The record of the menus while the inspector was told were discussed with the catering staff had not been fully reviewed since 2005. The records provided for the weekly testing of the fire system identified that during October and December only three tests had been recorded for each of the months. One of the emergency lights had a repetitive fault; this had been on going since 11 January 2006. This was part of ongoing work, the location of the light was not detrimental to the safety of the residents; but should have been rectified. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 7 This report will contain requirements and recommendations. 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 Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 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 The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, Standards reviewed were 1,3, This judgement has been made using available evidence including a visit to this service. The recently updated Statement of Purpose would provide information for any person to make an informed choice about the home. No service user including a respite application would be admitted without a full assessment of their health and welfare needs. EVIDENCE: During the inspection the registered care manager provided the Commission with a copy of the updated Statement of Purpose for the file. The document provides any person with all the information about the home, its facilities and The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 10 philosophy. This document was readily available to visitors to the home located within the front door entrance. From the care plans evidenced there were documents that identified a pre assessment of individuals needs had taken place prior to admission. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Standards 7,8,9,10 were reviewed This judgement has been made using available evidence including a visit to this service. The sample of care plans chosen at random identified that there were areas that required reviewing to protect the residents. The medication system was failing to identify when daily medication was administered. Out of date medication used could be detrimental to a resident’s health. Staff were competent and qualified to provide quality personal care and understanding. Arrangements were in place for the continued health care of residents from other professional agencies. EVIDENCE: The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 12 The sample of care plans chosen at random were identified not to contain all the relevant risk assessment to protect residents when taking calculated risks. The risk assessments seen had not been reviewed recently; one since 2005. The management need to incorporate risks of falls into plans where necessary. One care plan seen was without a contract of the terms and conditions. It was not ascertained how many other residents were without a contract. No photographs were located on the plans seen. This was a recommendation made on the previous inspection report in January 2006. The plan for one person did not identify the care for the diverse needs of this resident. Arrangements and records evidenced that residents were provided with other professional care from external agencies. The inspector had concerns in respect of medication and the lack of recording “gaps” in the medication records where in particular the weekend staff had not signed for medication administered. The previous inspection report made it a recommendation to monitor the practice. Identified on the day was that eye medication, which was a week out of date, had been administered. The box was clearly dated to show when it should have been discarded. One persons cream was being used out of sync, the senior person on duty rearranged the creams into the correct date order. The staff on duty were warm in their approach to the residents and their needs; assisting when necessary. They confirmed that their obligatory training was current. Some staff told the inspector that they had recently received and enjoyed training in awareness for the care of people with Dementia. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 12,13,15 were reviewed This judgement has been made using available evidence including a visit to this service. There was limited recorded evidence of activities that were provided especially for those residents with diverse needs. The residents were observed to maintain contact with families and friends. Catering was based on home cooking; the liquidised meal could have been made more attractively presented. EVIDENCE: The inspector evidenced activity taking place in the large lounge, residents were involved with a quiz. In the other lounge residents were without a member of staff, a number of them were asleep. One resident told the inspector that she was bored; the others were asleep and did not communicate when they were awake. The The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 14 television was not on and no music was playing. There was no stimulation within the lounge; this was discussed with the manager later. The lounge located in the front of the home had no stimulation at all; these residents were mentally frail. This was discussed with the manager who informed the inspector that the group in the top lounge were not always the first area where activities were promoted. The activity person had been spoken with previously to extend her skills and time spent in other groups in the home. There were limited written records for activities, they tend to be recorded as and when time allows. Staffs and management informed the inspector that each of the lounges had been to a local pub for a Christmas lunch; entertainers were a regular feature of the home. The inspector observed two sets of visitors visiting the home, each one confirmed the views expressed in the three comment cards; that the home, staff and care at Foxwalls for their particular relative was exceptional. The staffs “were thoughtful” “ the home remains the same in its high standards whenever we visit” The main kitchen is located off the large front lounge; each of the other units had a small kitchenette where breakfast could be prepared. The main meal of the day was a meal heavy in carbohydrates. Menus while discussed with the cooks by the management identified that they had not been fully reviewed since 2005. The required temperatures were current and maintained daily. This week’s menu was seen, over a period of five days a resident could have the alternative of fish, for some days this could be served twice a day. There was a need to review the menus to ensure they were more balanced. One resident had a liquidised meal, due to a problem swallowing. The cook of the day had liquidised spaghetti in tomato sauce with fish fingers together; this was then served to the resident. This was later discussed with the manager at feedback. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards 16,18 were reviewed. This judgement has been made using available evidence including a visit to this service. Residents were protected from abuse via the training provided for all the staff. The home had a robust policy and procedure in the event of complaints being raised. EVIDENCE: Staff confirmed that they had received Vulnerable Adults training, which was on going for the remaining staff. The commission or management had received no complaints against the home or care the staff provided. The home had reproduced the complaints procedure within the Statement of Purpose and Service Users Guide; each document was readily available. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent, Standards reviewed were 19 20 21 23 24 25 26. This judgement has been made using available evidence including a visit to this service. A tour of the home was included in the visit. The home was exceptional in its hygiene, the fixtures and fittings were of a good quality and well maintained. EVIDENCE: Located near to houses, the home has undergone changes, refurbishment and upgrading of the facilities provided. Residents bedrooms were sampled and found to contain personal possessions that had been brought in. residents spoken with were complimentary of their The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 17 rooms and the high standard the staff kept them. Linen observed in the sample of bedrooms was crisp, well laundered and pressed The newer wing had en-suite facilities; other bathing and toilet facilities were located near to communal and private bedrooms. Each one was tasteful in decoration and design and well maintained. Residents were provided with a comfortable warm home, high in its standards. Corridors were wide and contained stylish pictures. There was sufficient room for residents to walk about freely, there was a small area located near to the office where residents can sit and relax. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards reviewed were 27,28,29 30 This judgement has been made using available evidence including a visit to this service. Staffing levels appeared adequate to meet the needs of the residents, the deployment of staff needs to be kept under review to promote interaction in the lounges. Residents’ safety was maintained via the robust training programme for staff. Recruitment practices were vigorous to ensure the safety of the residents; the management need to update the staff records to ensure they were complete. EVIDENCE: At the time of this inspection there were no vacancies for staff. Staffing levels on the day appeared adequate to meet the needs of the residents. The inspector observed that while visiting two of the lounges there were residents left unsupervised. Staff were in other parts of the unit. This practice may be a potential risk to the more vulnerable residents. The inspector accepts that The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 19 other residents needs have to be recognised and respected. The manager needs to consider the deployment of the staff to provide stimulation and interaction; so residents were not “bored” The home had four staff undertaking the National Vocational Qualification in Care, when complete the home will have achieved over 50 of staff qualified. Recruitment ensured that the residents were safeguarded from abuse. Evidenced in the small sample of staff records identified that the manager was required to review the staff records to ensure that they contain all the required elements of the National Minimum Standards including a copy of a birth certificate and current photograph. From the information provided in the pre inspection questionnaire and discussions with the manager and staff who confirmed that the obligatory training was current. Additional training included diabetes and mental health. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate, Standards reviewed were 31,33,36,38 This judgement has been made using available evidence including a visit to this service. The home was operated to the best interest of the residents, managed by management who demonstrated her commitment to the home. The home had a system in place to obtain comments annually. On going formal supervision identified any training needs to best support the residents. The records for the weekly testing of the system for two months were incomplete; this could leave residents at risk. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Head of Home and registered care manager confirmed that all her relevant training required was current. The manager had a relaxed style; this was evident during the inspection. The style was cascaded to her staff ensuring the residents life style where possible was undisturbed. The residents completed annual surveys where possible; relatives were seen on a regular basis, management were available to provide information at any time. Meetings were arranged for each residents lounge, records were taken. Staff confirmed that they had formal supervision on a regular basis; training and development needs were part of the supervision. The records provided in respect of the weekly testing of the system identified that for the months of October and December 2006 only three tests were recorded for each month. It is important that if the first person responsible for undertaking the tests is of duty then an alternative person should complete the test. Discussed with the Head of Home was the contingency plan and risk assessment of the residents in the event of an emergency. The home had completed the annual risk assessment of the home in 2007. Each of the staff had been involved in an active fire drill during 2006. Records identified that an emergency light has had a repetitive fault since November 2006; the inspector was told was an engineering problem. The light is located away from the residents living area. The problem should have been sorted out long before this inspection. The home maintained a regular check on the water accessed by the residents. Staff and the management continued to update and review their obligatory training needs this was evidenced from the records and by verbal confirmation from staff spoken with. The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 X 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X X 3 3 2 The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 & 13 Requirement Timescale for action 20/03/07 2 OP9 13 (2) 3 OP12 16 (n) 4 OP15 16 (i) The registered person shall keep the care plans under review. Records should evidence the social needs of residents with diverse needs Unnecessary risks to the health or safety of the residents should be identified and as far as possible eliminated The registered person shall make 20/03/07 arrangements for the recording and safe administration of prescribed medications. Staff should adhere to the homes policies on medication. To consider re-training for the staff where necessary The registered person shall 20/03/07 consult with residents in respect of the programme for any activity. All the residents should have access to activities/ stimulation to meet their diverse needs. The registered person should 10/03/07 after consultation review the menus to provide a balance diet. The specially prepared meals should be reviewed to present it in an attractive manner. DS0000035821.V326956.R01.S.doc Version 5.2 The Foxwalls Page 24 5 OP38 23 (4) The registered person shall ensure that at all times the weekly testing of the fire system is adhered to 10/03/07 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 Refer to Standard OP27 OP29 Good Practice Recommendations To review the deployment of the staff to ensure the residents were supervised and stimulated To revisit the staff records to ensure that all the relevant information is on file to comply with Schedule 2 The Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Foxwalls DS0000035821.V326956.R01.S.doc Version 5.2 Page 26 - 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!