Care Home: Fenwick House

What the care home does well The service has appointed a person who is responsible for making sure its policies and procedures are in place and up to date. They have introduced a monitoring system where she oversees the recruitment of staff as one example. This means that staff have clear guidance on how they should be working in the home. People living in the home feel that there is a relaxed and informal atmosphere. One person said, "I feel comfortable here, there are no airs or graces". Another person described the home as "laid-back". What has improved since the last inspection? Medication systems for ordering and storage are good. Previously not all staff have been proficient in writing down the balances of medication when received into the home. Management had acted swiftly and made changes to stop this happening again. When we audited medication at this visit everything was correct and people had received their medication when they should have. We had made a requirement at the last inspection about having the correct paperwork in place, before allowing someone to work at the home. This was now being done, although copies should be available in the home. What the care home could do better: Areas that need to improve include: Some of the areas in the home were not clean. In one of the sitting rooms we saw that the skirting boards contained a large amount of dust and stains. Some of the armchairs had dirty arms and legs, this is where something had been spilled, but because it was not cleaned quickly it had become congealed. This does not provide a pleasant environment for people to live in. Staff must be more careful when assisting people with their daily needs. One person had dirt under their fingernails, and others had not received assistance to comb or brush their hair. Staff had not always completed an accident form when they should have. This has to happen to comply with the law and to help make sure that the correct follow up is carried out. We reported at the last inspection that there had been improvements in the care documentation, however standards had fallen again at this visit. The entries made by staff were basic and they did not fully describe how the needs of people should be met. Key inspection report Care homes for older people Name: Address: Fenwick House 1 Cowper Road Fenwick House Bedford Bedfordshire MK40 2AS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Fenwick House 1 Cowper Road Fenwick House Bedford Bedfordshire MK40 2AS 01234350887 01234350887 hansa-waghe@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: WAGh Ltd T/A Fenwick House care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: A maximum of 10 beds can accommodate service users in the category of DE(E). The rooms on the top floor of the home can only accommodate service users in the category OP who have good mobility and eyesight and do not require personal care. Date of last inspection Brief description of the care home Fenwick House is a large detached house that has been extended and converted for use as a residential home several years ago. It is located in a pleasant residential area of Bedford with convenient access to the amenities of the town. It was registered to provide care for thirty people 65 years of age or over, 10 who may have dementia. The home has twenty-six single rooms and two that could be used for double occupancy. The bedrooms are distributed over three floors. There are two steps up to four of the bedrooms on the first floor. The bedrooms on the second floor can only be accessed by a steep staircase. These bedrooms are not suitable for those with mobility problems Care Homes for Older People Page 4 of 28 Over 65 10 30 0 0 Brief description of the care home and an occupational therapist has recommended that these rooms are not used by residents due to the steepness of the stairs and the decreased tread depth. Three communal lounges are provided on the ground floor as well as a large dining room. One lounge is designated for smoking, the others are non-smoking. There are toilet, shower and bathing facilities on the ground and first floor. The current range of fees is from £425.00 for a shared room to £456.06 a week for single accommodation. In addition extra charges are made for hairdressing and chiropody services and newspapers. Any charges incurred for private dentistry or ophthalmic services are the responsibility of the individual. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 16th December 2009. The care of two people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. The home had 9 vacancies and 1 person was in hospital. Therefore it must be taken into consideration, that the findings following this inspection are not based on a fully operational home and the effect and or differences that full occupancy may have, on the outcomes for people living at the home. Care Homes for Older People Page 6 of 28 During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practise and communication between the people living at the home and staff was also made at the inspection. Prior to the visit taking place the Care Quality Commission had sent to the home an Annual Quality Assurance Assessment (AQAA). This was returned prior to the visit and provided information on how the service self assess their own performance. During the visit we checked some of this information to make sure that what had been submitted was accurate. The focus of this inspection was to look at the key standards. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information on the home is sufficient to ensure people can make an informed choice as to whether to move into the home or not. Evidence: A copy of the statement of purpose was examined. The document provided information on the staffing, accommodation and services available at the home. People when asked advised that they had seen a copy. People who were able to indicate stated that they had been told about the home, before they decided to move into it. One person who had moved into the home recently confirmed that their relative had visited before they made a decision on whether to move into the home. Both of the files examined contained an assessment of the persons needs. one person who had recently moved into the home had an additional assessment, this had been undertaken by social services. With the combined information from both areas there was sufficient information to establish the needs that had to be met. However it Care Homes for Older People Page 11 of 28 Evidence: should be noted that if assessment information from social services is not available, the standard of recording by the home must improve substantially, as their own assessments were insufficient. Intermediate care is not provided at the home. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistencies in care planning and the delivery of physical support place some people at risk of not receiving the care that they need. Evidence: At the previous inspection it was reported that improvements had been made to the standard of care documentation, however shortfalls were again identified at this visit demonstrating that the service had not been able to sustain any improvements that they had made. One person had been assessed as being at risk of falling, yet the guidance to staff gave no indication as to what had been done to reduce this risk. There was no evidence even after speaking with staff that any actions had been taken. In addition entries made by staff were not person centred, there was no individual information to guide staff on how exactly the person should be supported. Further documentation and assessment needs to improve. The process for assessing risk relating to moving and handling, nutrition and skin integrity needs to be consistent. Also the reporting of a fall by one person had not been undertaken, the only information written about this Care Homes for Older People Page 13 of 28 Evidence: was by a visiting District Nurse. Several of the people at the home had an unkempt appearance. We spoke to a member of staff about this, they advised this was their choice or they had been sleeping in their chair. Some people do choose not to have their hair combed, however the amount of people indicated that this was not all choice. In addition one of the two people case tracked had dirt under their fingernails, and appeared not to have been supported to have a shave for at least two days. Everyone at the home is registered with a General Practitioner. Documents viewed demonstrated that a District nurse had visited one person when they required nursing intervention. People spoken with confirmed that the staff would arrange for a Doctor to come and see them if they were unwell, they indicated that they would always do this straight away. Medication storage in the home was noted to be satisfactory as was the ordering of medicines. The recording of medication stocks and balances were sufficient so an audit of the medication systems was possible. The medication administration records were seen to contain the signature of staff and showed that medication had been given as prescribed. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to continue personal relationships and participate in social activities to meet peoples individual preferences and emotional needs in this area. Evidence: People spoken to stated that they enjoyed their meals. We observed the serving of the lunch time meal. Most people sat in the dining area of the home to eat their meal. A white board contained the menu choices for the day. Some people needed their food to be liquidised due to swallowing difficulties for example. However all vegetables had been mixed together, this resulted in a brown substance on their plate. The presentation of liquidised meals must be the same as all others served. As previously assessed staff had made arrangements for daily activities and had maintained a daily record that included activities include sing-along, board games, reminisce, crayons colouring, dominoes, and watching television. Also as previously assessed on speaking to people who lived in the home, they confirmed that their relatives and friends visited them. In addition one relative was spoken to they said that they visited frequently, and they were always offered a drink and no restrictions had been made to them. None of the people spoken with were Care Homes for Older People Page 15 of 28 Evidence: aware of any restrictions on visiting and all confirmed that they could meet with their friends and family within the privacy of their own rooms. Daily records also contained entries by staff to indicate when people had received visitors. Information was also available so staff would know whom to contact if a person had a change in circumstance. Documents that were read demonstrated that people were able to receive visitors, entries showed that staff would contact them if there had been a change to someones circumstances. We spoke with one person who confirmed that his wife came into to see him regularly. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service has a complaints policy on display that is easily accessible to residents and visitors alike. Evidence: Within the statement of purpose there was information on whom to contact if you wished to make a complaint. At previous inspections records were seen at that time to show how complaints had been responded to and what action had been taken to remedy any shortfalls and this was assessed as meeting this standard. No complaints had been received by the service since our last visit. The management of complaints and concerns were seen to be important to the owners and management of the service as they felt it was another way that they could improve the service. The home had in place a policy on abuse and a copy of the most recent guidance for the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse. Training records showed staff had received training in this area. During the interviewing of staff they were able to demonstrate that they knew how to report any concerns. Information supplied by the service showed that people can be provided with advocacy service information and that people use the postal voting system. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment generally meets the specific needs of the people who live here. There home has a programme of decoration, which is on gong and remains work in progress at present. Evidence: As assessed at the previous inspection earlier in the year the owner has continued to make some investments in the environment of the home and now has a planned programme of refurbishment and redecoration. Many carpets, particularly those in halls and stairways, have been replaced and all of the vacant bedrooms have been redecorated. Staff and people living in the home were pleased with the difference this had made to the living areas. As assessed previously the dining room had been improved with new chairs that matched and were more comfortable. The manager had also bought new table linen and vases of flowers had been placed on each table. The dining room was well used as most of the residents took all their meals in this room. The flooring in the bathrooms and toilets had been improved. The front garden was tidy. The home has three separate lounges, one that is a designated smoking area and a Care Homes for Older People Page 18 of 28 Evidence: dining room in addition to individuals bedrooms. None of the bedrooms were being used as shared accommodation at the time of the inspection. Areas of the home were clean and tidy, for example the dining room. However other areas were not clean. One of the sitting areas contained furniture that had stains on them, the skirting boards were also dirty and had a high level of dust on them. Washroom facilities are distributed throughout the building, with clear, picture signage on the doors, to enable residents with cognitive impairment to identify these areas more easily. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support by staff is not always sufficient to provide the care and support needed by the people living at the home. Evidence: On examination of two staff files to look at recruitment practises not all information required was in place. However supplementary evidence was submitted following the site visit and confirmed the following was in place: proof of identity, Criminal Records Bureau clearance, verification of employment history and references. This information needs to be available in the home. As formerly assessed staff receive induction and on-going training. Staff training that takes place includes COSHH, Fire, First Aid, Health and Safety, Moving and handling and safeguarding of adults. On the day of this visit there were 17 people living at the home. The rota showed that there should have been 4 staff on duty throughout the day. On meeting and speaking with the staff this was seen to be correct. The owner advised that she would always review staffing levels and changes these if dependency levels changed or the number of people living in the home increased. Observations were made of staff supporting and providing care to people. As assessed Care Homes for Older People Page 20 of 28 Evidence: previously a good rapport existed between the staff and people living in the home staff took time to explain to each person what was happening and they were given the opportunity to express their own wishes. All comments received were positive regarding how staff treated them at the home.However the outcomes for people as indicated within the health and personal care section of this report, need to improve. Staff had not acted correctly when an accident had occurred, care documents were not fully up to date and we found one person still had a hospital bracelet on nine days after discharge. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are not sufficient to ensure an acceptable level of service is provided for the people living at the home. Evidence: Historically requirements have been made regarding this service and the evidence shows that they would be complied with at one inspection, but by the next, standards would have fallen again. The manager has worked at the service for more than twenty years, she had worked to wards meeting requirements made in September 2008 as assessed at the previous inspection, however non compliance in areas has occurred again. The owners must now review the service as a whole and introduce quality assurance systems to prevent this repeating again. The manager and the maintenance man were responsible for health and safety checks including water temperatures and fire checks. These were all carried out regularly and recorded. It was clearly recorded that when a problem had been identified the action had taken to rectify the problem. Care Homes for Older People Page 22 of 28 Evidence: As previously assessed documentary evidence was seen that showed that the home had undertaken a survey to gain the views of people living at the home and. A breakdown of responses had been undertaken and was available for inspection. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A care plan containing sufficient information that is clear must be in place for each assessed need and kept up to date when changes occur, to ensure people receive the care and support that they require This is to ensure people receive the care and support that they require. 05/02/2010 2 8 12 Action and reporting of 05/02/2010 injuries and falls and incidences must be made in accordance with the homes policy, monitoring and follow up must be made by staff and medical attention sought when an injury has occurred. This is to maintain the safety and well being of the people living at the home. Care Homes for Older People Page 25 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 10 12 People must always receive 05/02/2010 the support needed to maintain an acceptable level of personal hygiene. This is to ensure they can live their lives in a dignified manner. 4 26 16 All areas of the home must be clean and free of odours. This is so that people have a pleasant environment in which to live. 19/02/2010 5 30 18 Staff must have the skills 05/02/2010 and competency to meet the individual needs of a person before being allowed to provide care to them. This is to ensure the safety and the protection of people using the service. 6 31 9 Management systems are not sufficient to ensure an acceptable level of service. 26/02/2010 This is to ensure an people receive the care they need. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 All meals should be presented the same, irrespective of Page 26 of 28 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations whether they have been liquidised or not. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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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