Care Home: Fistral House

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What the care home does well The home was well maintained, pleasantly decorated in a homely way, and was very clean with no offensive odours. The garden was well maintained and provided a very attractive and pleasant place for people to sit. People were very complimentary about Mrs Dowling and her staff in respect of their consideration, the care and support provided by the staff team, and the way people’s privacy and dignity is respected. The number of staff on duty meant that the staff could respond immediately if someone needed them. Care planning documentation contained people’s daily and night time routines to make sure that individual needs are met in the way, and at the time, that they want. The home provides toiletries and stockings for people who live in the home if they want them and they are not expected to pay for these items. Neither are people charged for telephone calls made using the home’s ‘phone, for transport or for any trips out. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 What has improved since the last inspection? People’s personal and healthcare needs were recorded in the care planning documentation so that staff could meet people’s needs in a consistent way. Records relating to the administration of medication were up-to-date and there was an accurate audit trail of medication in and out of the home. Prescribed creams were recorded in the care plan. All staff have received training in how to protect vulnerable people from harm and receive regular supervision from the manager or Head of Care. Money belonging to people who lived in the home that was looked after by the manager was not being pooled with other people’s money. Records relating to the administration of medication were upto-date and there was an accurate audit trail of medication in and out of the home. People living in the home were reminded what was on the menu each day by the use of menu cards. Checks and tests of fire safety equipment were being carried out and all staff had received training in fire safety awareness. The windows above the ground floor had restrictors fitted so that people could not fall out of them. The complaints procedure has been updated and was available in the home’s Statement of Purpose. The staff training programme has continued to be developed and implemented to ensure that all staff received training appropriate to the work they are to perform, and to ensure the safety of themselves and others. The staffing rota clearly identified who was on duty and what each person’s role was on each occasion. The car park at the front of house has had new tarmac laid down and a new front gate has been fitted. The home has purchased various new items, such as a refrigerator and new valves have been fitted to all the radiators. What the care home could do better: Whilst each person in the home had a plan of care saying how their needs should be met, these could be improved by being more person-centred to include more information about, for example, their previous lifestyles and histories. Also, where a potential risk of falls or poor nutrition is identified, risk assessments should be carried out to identify how the risks should be managed and reduced. Most people who lived in the home did not require assistance with eating their meals but some people were having a little difficulty. Therefore it would be useful to establish whether people’s independence could be enhanced by the provision of assistive devices, such as plate guards to keep food on the plate, or cutlery with large handles, which some people may find easier to hold and use. The home had an adult protection policy in place but it needs to include clear instructions that comply with the guidance issued by the Local Authority, aboutFistral HouseDS0000008927.V376902.R01.S.doc Version 5.2 what action to take should an allegation or incident of abuse or neglect be made or suspected. Also, whilst staff receive in-house training about adult protection issues, it would also be beneficial for them to attend the training provided by the Local Authority so that they are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. The home was generally well maintained but the décor was looking tired and worn in places, particularly in bedrooms and en suite facilities. Therefore a programme should be developed to renew the décor and furnishings of bedrooms/en suites so that the home is kept up to date and people are able to use the en suite facilities. Also, every bedroom door should be fitted with a suitable lock so that people can stop unwanted entry by others, enhance their privacy and ensure their belongings are secure should they be absent from the home for any reason. Recruitment procedures were generally satisfactory but need to be improved to make sure that, on every occasion, two written references are obtained for all new staff members before they start working in the home. This is to ensure that only suitable staff are employed and protect the people who live in the home from risk of harm. Staff were expected to complete induction training but it was taking some time and should be completed more quickly. This is to ensure that they are trained and competent to do their jobs. The home had a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the services and facilities in the home. This is so that any shortfalls are identified and rectified to demonstrate that the home is being run in the best interests of the people who live there. The manager could not find documentary evidence during this inspection that the electrical wiring in the home had been checked and this was not produced at the last inspection either. Therefore a copy of the home’s electrical wiring certificate should now be sent to the Care Quality Commission as soon as possible to confirm that the electrical wiring system is safe. Key inspection report CARE HOMES FOR OLDER PEOPLE Fistral House 3 Esplanade Road Pentire Newquay Cornwall TR7 1PY Lead Inspector Antonia Reynolds Key Unannounced Inspection 17th August 2009 09:35 DS0000008927.V376902.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 2 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 Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fistral House Address 3 Esplanade Road Pentire Newquay Cornwall TR7 1PY 01637 878423 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) Mr Geoffrey Ernest Dowling Mrs Rita Gladys Dowling Mr Geoffrey Ernest Dowling Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include accommodation for two named persons only outside of the age range and other category of the home. 1st September 2008 Date of last inspection Brief Description of the Service: Fistral House has been a care home for many years and provides personal care and accommodation for up to thirteen people, usually over the age of 65. It has been privately owned by Mr and Mrs Dowling since 1998. The home is located in a residential area of Newquay directly opposite Fistral beach. It is fairly close to local shops and to bus services into Newquay and the railway station. The home has nine single bedrooms and two double rooms which are located on the ground and first floors. All the bedrooms have en suite toilets with seven of these also having en suite showers and one with an en suite bath. There are stair lifts to the bedrooms on the first floor. The lounge and dining rooms are on the ground floor and there is a conservatory at the front of the house where people can enjoy the view over Fistral beach. There is a garden at the back of the house that is level and spacious with seating for people to use. There is parking space at the front of the house and on street parking is available nearby. In August 2009 the fee levels ranged from approximately £450 per week depending on peoples needs. Information about the home and copies of inspection reports can be obtained from the manager who is in day to day control of the home, Mrs Rita Dowling. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection consisted of an unannounced visit to the home by one inspector between 9.35am and 5.55pm on Monday, 17th August 2009. The inspector was accompanied by an Expert by Experience. Throughout this report the term we will be used as the report is written on behalf of the Care Quality Commission. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. Four people living in the home were spoken with during the visit and three surveys were returned from them, two of which had been completed by relatives. Four staff members were spoken with and three surveys were received from staff. Three surveys were received from healthcare professionals. Mrs Dowling, who will be referred to as the manager throughout this report, and the home’s Head of Care were available for consultation and discussion during the inspection process. What the service does well: The home was well maintained, pleasantly decorated in a homely way, and was very clean with no offensive odours. The garden was well maintained and provided a very attractive and pleasant place for people to sit. People were very complimentary about Mrs Dowling and her staff in respect of their consideration, the care and support provided by the staff team, and the way people’s privacy and dignity is respected. The number of staff on duty meant that the staff could respond immediately if someone needed them. Care planning documentation contained people’s daily and night time routines to make sure that individual needs are met in the way, and at the time, that they want. The home provides toiletries and stockings for people who live in the home if they want them and they are not expected to pay for these items. Neither are people charged for telephone calls made using the home’s ‘phone, for transport or for any trips out. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst each person in the home had a plan of care saying how their needs should be met, these could be improved by being more person-centred to include more information about, for example, their previous lifestyles and histories. Also, where a potential risk of falls or poor nutrition is identified, risk assessments should be carried out to identify how the risks should be managed and reduced. Most people who lived in the home did not require assistance with eating their meals but some people were having a little difficulty. Therefore it would be useful to establish whether people’s independence could be enhanced by the provision of assistive devices, such as plate guards to keep food on the plate, or cutlery with large handles, which some people may find easier to hold and use. The home had an adult protection policy in place but it needs to include clear instructions that comply with the guidance issued by the Local Authority, about Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 7 what action to take should an allegation or incident of abuse or neglect be made or suspected. Also, whilst staff receive in-house training about adult protection issues, it would also be beneficial for them to attend the training provided by the Local Authority so that they are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. The home was generally well maintained but the décor was looking tired and worn in places, particularly in bedrooms and en suite facilities. Therefore a programme should be developed to renew the décor and furnishings of bedrooms/en suites so that the home is kept up to date and people are able to use the en suite facilities. Also, every bedroom door should be fitted with a suitable lock so that people can stop unwanted entry by others, enhance their privacy and ensure their belongings are secure should they be absent from the home for any reason. Recruitment procedures were generally satisfactory but need to be improved to make sure that, on every occasion, two written references are obtained for all new staff members before they start working in the home. This is to ensure that only suitable staff are employed and protect the people who live in the home from risk of harm. Staff were expected to complete induction training but it was taking some time and should be completed more quickly. This is to ensure that they are trained and competent to do their jobs. The home had a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the services and facilities in the home. This is so that any shortfalls are identified and rectified to demonstrate that the home is being run in the best interests of the people who live there. The manager could not find documentary evidence during this inspection that the electrical wiring in the home had been checked and this was not produced at the last inspection either. Therefore a copy of the home’s electrical wiring certificate should now be sent to the Care Quality Commission as soon as possible to confirm that the electrical wiring system is safe. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Fistral House DS0000008927.V376902.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 Fistral House DS0000008927.V376902.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. EVIDENCE: Discussions with people who lived in the home as well as information in surveys confirmed that they were given information about the home, and had opportunities to visit, before they moved in. The files of three people who lived in the home, including a person who had recently been admitted, were inspected. These showed that an assessment of people’s individual needs was carried out before people came to live in the home to make sure the home could meet those needs. Surveys from staff members confirmed that they had enough information about peoples needs to provide the care required. The admission process included visits to the home to meet the other people who Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 10 lived there and staff, so that people had a chance to assess the quality, facilities and suitability of the home. Fistral House does not provide intermediate care. Fistral House DS0000008927.V376902.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the 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 who live in the home are treated with respect and personal support is offered in a way that makes people feel safe, well cared for and promotes their privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. EVIDENCE: Those people able to comment, as well as surveys from people who lived in the home, confirmed that the staff provided personal care in a respectful way that preserved peoples privacy and dignity at all times. Everyone spoken with praised the attention they received from the staff. Staff were observed knocking on bedroom doors before entering and people said that the staff always made sure bedroom, bathroom and toilet doors were closed when they needed assistance with personal care. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 12 People may have their own telephone in their bedrooms, at their own expense, if they wish to. However the home had a telephone system with portable handsets and people could use this to make and receive private telephone calls, for which they were not expected to pay. Discussions with those people who were able to comment and staff, as well as information contained in personal files, confirmed that people living in the home had access to health care services such as doctors, district nurses, dentists, chiropodists, opticians and hospital consultants. Two healthcare professionals, in surveys, said that people “appear … well cared for” and that the care and dignity of people was maintained “to a very high standard”. The files of three people who lived in the home were inspected and these contained individual care plans, including day and night routines, with information on care needs and how staff at the home would meet those needs. Wherever possible people have signed these care plans to show that they were in agreement with the content. Peoples files contained the names and addresses of their relatives and representatives so that staff knew who to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to skin/pressure area care and moving and handling. One contained a risk assessment about that person’s nutritional needs but information contained in someone else’s file indicated that they may also need a nutritional assessment. There were no assessments on the files to show that risk assessments had been carried out in relation to the possibility of people falling. Also care plans contained limited information about peoples social and personal histories, previous lifestyles, interests and routines or about future wishes and aspirations. However the manager said that this was being addressed and they have also asked relatives to participate in gathering this information together. Medication was stored securely and most of it was administered from blister packs prepared by a local pharmacist. None of the people living in the home at the time of inspection kept or administered their own medication. A staff member was observed administering medication in a safe and respectful way to the people who lived in the home. Records relating to the administration of medication were up-to-date and there was an accurate audit trail of medication in and out of the home. Information in a survey from the local pharmacist confirmed that the staff have received training in handling medication, they adhere to safe procedures, medication is kept under review and there was a good working relationship between the pharmacy and the home. Fistral House DS0000008927.V376902.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are relaxed and relatives and friends can be confident that they are welcomed. The dietary needs of the people who live in the home are very well catered for with a balanced and varied selection of food that reflects their tastes and choices. EVIDENCE: Discussions with the people who lived in the home and staff, as well as the home’s newsletter, showed that a range of activities was available. These included musical entertainers, a local theatre group, craft work such as making birthday and Christmas cards, flower arranging and planting bulbs and a second Christmas Dinner during the summer. People were enabled to attend a local church or other place of worship if they wished to go and a local minister also visited the home when requested. There were many photographs in the home showing people participating in various activities and trips out. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 14 Discussions with people living in the home, as well as the staff, confirmed that there was a set menu covering a three week period. Whilst this showed that there was only one choice of main meal available each day, alternatives were available if the menu choice was not to someones liking. Information in the AQAA said that menu cards were placed on dining room tables each day to remind people what they had chosen for their main meal. We were told by one person living in the home that the managers will buy any item of food if requested. The main meal on the day of the inspection was beef stew with dumplings, mashed potatoes and beans with strawberry gateau for dessert. People said they were very happy with the food and that there was plenty of it. People chose whatever they liked for their evening meal such as egg, beans or cheese on toast, toasted teacakes, sandwiches or scones. People were provided with a selection of fresh fruit of their choice in their bedrooms so they could help themselves. One person in a survey commented that “the food is very nice”. We noticed that some people were having difficulty eating their meals but there was no equipment, such as plate guards to keep food on the plate, or cutlery with large handles, which some people may find easier to hold and use. There was a visitor’s book in the entrance which showed regular and frequent visitors to the home. The people who lived there and the staff said that there were no restrictions on when people can visit and they were always made to feel welcome. Fistral House DS0000008927.V376902.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns are listened to and acted upon by the management team. EVIDENCE: The home had a written complaints procedure and surveys from people who lived in the home and their relatives confirmed that they knew how, and to whom, to make a complaint should they need to. People living in the home who were able to comment said they would talk to the staff or the manager if they had any concerns and this was observed during the inspection. All the surveys we received from the people in the home and their relatives confirmed that they had no complaints about the home. The manager said that they have not received any complaints about the home. The Care Quality Commission (previously the Commission for Social Care Inspection) has not received any complaints or concerns about this home since the last inspection on 1st September 2008. The home had a visitor’s book to record dates, times and names of all visitors to the home. There was a policy and procedure in the home for staff to follow regarding the protection of vulnerable adults. However this did not provide staff with a clear procedure to follow, in line with guidance issued by the Local Authority, should Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 16 an incident of abuse or neglect occur or be suspected. Staff training records and discussion with the manager and the Head of Care showed that all staff were expected to complete in-house training related to the safeguarding of vulnerable adults but most staff had not attended the training provided by the Local Authority. Discussion with one member of staff confirmed that she was knowledgeable about the local processes in place to safeguard vulnerable people. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 23, 24, 25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, clean and comfortable providing people with a pleasant and homely environment in which to live. EVIDENCE: We looked all round the home and found it was warm, comfortable, clean and free from offensive odours. A survey from one person living in the home commented that “they keep the place very clean”. The shared rooms consisted of lounge and dining rooms as well as a conservatory, which had a variety of seating for people to use. The home had a level, spacious and well maintained garden that people could walk around and sit in when the weather was fine. There were four bedrooms on the ground floor and seven on the 1st floor. All of these had en suite toilets, seven had en suite showers and one Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 18 had an en suite bath. However the manager said that the showers were not often used by the people who lived in the home because most of them preferred a bath. There were stair lifts to the bedrooms on the 1st floor to assist people with mobility difficulties. Bedrooms were reasonably well decorated, although some could do with updating, and contained many personal possessions. Whilst most bedroom doors had locks fitted and people could have keys if they wanted them, some doors (for example, rooms 5 and 7) did not have locks fitted. This should be addressed to ensure people’s privacy and security of their belongings should they be absent from the home for any reason. There was a communal toilet on each floor and a bath with a bath hoist on the 1st floor which we were told is what most people used. People told us they could have a bath whenever they wanted one. Other aids and adaptations to aid mobility and independence were seen around the home such as grab rails and commodes were available if required. Radiators have been guarded to reduce the risk of people being burnt. The manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people were not scalded, have been installed on all the hot water taps that were accessible by the people who lived in the home. She also said that the temperature of the hot water coming out of the taps was checked regularly to make sure these valves were working correctly. Laundry facilities were satisfactory and arrangements for controlling the spread of infection were seen including gloves and aprons for staff to use. There were covered systems in place for transferring soiled and potentially infected linens between bedrooms and the laundry. Whilst no-one specifically mentioned the quality of the laundry service, people were observed dressed in clean, ironed clothes. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of caring staff, who are trained to meet people’s needs, support the people who live in the home. Whilst recruitment practices are generally good they need to be more robust to ensure that people who live in the home are protected from any risk of harm. EVIDENCE: Information contained in staffing rotas, as well as discussion with the manager, showed that there were usually three or four care staff on duty in the mornings and two or three care staff in the afternoons and early evening, as well as the manager. In addition to the care staff there were also staff who carried out catering and domestic tasks. At night there was one waking member of staff and the manager was ‘on call’ as she lived on the premises. Surveys returned from three people who lived in the home and three staff members said that there were always enough staff in the home to meet the needs of the people who lived there. The people we spoke to during the visit also said that there were enough staff on duty and staff had time to talk and spend time with them. We observed that the call bell was answered immediately although it was not used very often as the staff were attentive and diligent in ensuring that people were comfortable and had everything they needed. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 20 People who lived in the home, as well as information in surveys from relatives, indicated that the staff were respectful, polite and caring. A relative in a survey commented that Mrs Dowling cares for her residents and it shows”. We observed that staff showed a very caring attitude towards the people who lived in the home. We examined the personal files of three recently recruited staff members. These showed that the required checks and references were usually obtained before people started working in the home. However one file only contained one written reference and two written references should be obtained for all new staff before they start working in the home. The manager said that, occasionally, new staff may start working in the home before a full check is received from the Criminal Records Bureau but they were always supervised until a satisfactory check was received. The manager and the Head of Care confirmed that all new staff were expected to complete a structured induction programme. However documentation in the home showed that new staff were taking some months to complete this. Discussions with staff members, as well as information contained in surveys, confirmed that the training they received does include everything they needed to know to do their job. Staff spoken to said they worked well as a team and that Fistral House was a good place to work. In particular they praised the training available to them and the support they received, from both peers and management, to do their job. One staff member commented that “it’s a really great place to work … we all get on like one big happy family”. Each staff member had an individual training and assessment plan to identify specific training needs. Information in the AQAA confirmed that over half of the staff team have obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQ) at level 2 or above. In addition staff were expected to complete training in moving and handling, emergency first aid, health and safety, food hygiene, safeguarding vulnerable adults, principles of care, dementia and conflict resolution. Some staff had also attended training on human rights including the Mental Capacity Act and deprivation of liberty safeguards so were up to date on recent changes in social care legislation. Surveys from three staff members confirmed that they have good training opportunities and they have enough training to do their jobs well. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 People using the 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 living in the home can be confident that it is run in their best interests. The health, safety and welfare of the people living in the home are promoted and protected. EVIDENCE: The manager who was in day to day control of the home, Mrs Rita Dowling, has been managing Fistral House since 1998 and was supported by a Head of Care. Mrs Dowling was a registered nurse and has a completed a management course, namely the Registered Managers Award. The management team operated an open door policy and feedback from people who lived in the Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 22 home, their relatives, staff as well as a healthcare professional indicated that they were very supportive and always available to discuss any issues or concerns. A relative commented that Fistral House is an exemplary care home. Discussion with the manager, as well as documentation and surveys from staff, showed that the staff had regular staff meetings and 1:1 supervision meetings were taking place. Discussion with the manager and Head of Care said that these included observation of staff providing personal care to make sure they were doing it properly and in accordance with the persons wishes. Training records showed that care staff were expected to complete training in emergency first aid, food safety/hygiene, moving and handling and health and safety. Discussion with the manager, as well as documentation, confirmed that the financial affairs of the people who lived in the home were managed by themselves, their families or representatives. The home did administer spending money on behalf of some people who lived in the home but were only holding a small amount of cash for one person at the time of inspection. Individual records were kept of money paid out on behalf of the people who lived in the home, for example, for hairdressing, chiropody and newspapers, and money paid in by relatives. The fire safety equipment records showed that checks and tests of the fire safety equipment were carried out regularly and a local contractor serviced the fire alarm system and fire extinguishers at least annually. Information contained in the staff training records showed that staff have received training in fire safety awareness and/or attended a fire drill. The manager said that all the radiators were guarded to reduce the risk of people being burnt and all radiators seen during the inspection were guarded. The manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people were not scalded, were installed on all the hot water taps accessible to the people who lived in the home, as well as the bath. The manager also confirmed that procedures were in place to reduce the risk of legionella occurring. The manager that all the windows above the ground floor had window restrictors fitted and the ones that we inspected were in working order. Information in the AQAA showed that the home had an electrical wiring certificate dated November 2008 but this could not be found on the day of inspection. The previous inspection also found that documentary evidence to show that the electrical wiring in the home was safe could not be found during that inspection. Documentation showed that all portable electrical appliances in the home had been checked for safety in November 2008. Servicing records showed that the stair lifts had been serviced in July 2009. The home had a quality assurance system in place and questionnaires were distributed to people living in the home on a regular basis to ask them for Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 23 feedback on the quality of care they received. The results were collated and the outcome published in the home’s newsletter. However the process did not include an annual internal audit of the services and facilities in the home and, if this had taken place, may have identified the issues raised in this report. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 24 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP7 Good Practice Recommendations Care plans should contain risk assessments relating to falls and nutrition when these issues are identified as potential risks. They should also contain more detailed information about people’s social and personal histories, their previous lifestyles, interests and routines, as well as future wishes and aspirations. This is to provide a more person-centred approach to care planning so that staff know more about the people they are caring for. Assessments should be carried out with people who live in the home to see if additional equipment may assist them with eating their meals, such as plate guards to keep food on the plate, or cutlery with large handles, which some people may find easier to hold and use. This is so that people are supported to be as independent as possible. The home’s adult protection policy should include clear instructions that comply with the guidance issued by the Local Authority, about what action to take should an DS0000008927.V376902.R01.S.doc Version 5.2 Page 26 2. OP15 3. OP18 Fistral House 4. OP18 5. OP19 6. OP24 7. OP29 8. OP30 9. OP33 10. OP38 allegation or incident of abuse or neglect be made or suspected. All staff should attend the training provided by the Local Authority on safeguarding vulnerable people. This is to ensure that staff are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. A programme to renew the décor and furnishings of bedrooms and en suite facilities should be put into place. This is so that the home is kept updated and that people are able to use the en suite facilities in bedrooms. Every bedroom door should be fitted with a lock suited to people’s capabilities and accessible to staff in emergencies. This is so that people can stop unwanted entry by others, enhance their privacy and ensure their belongings are secure should they be absent from the home for any reason. Two satisfactory written references should be obtained for all new staff members before they start working in the home. This is to ensure that only suitable staff are employed and protect the people who live in the home from risk of harm. All new staff should complete their induction training within six weeks of appointment to their posts. This is to ensure that they are trained and competent to do their jobs. The quality assurance system should be developed to include an annual internal audit of the services and facilities in the home. This is so that any shortfalls are identified and rectified. A copy of the home’s electrical wiring certificate should be sent to the Care Quality Commission to provide documentary evidence that the electrical wiring in the home is safe. Fistral House DS0000008927.V376902.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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