Care Home: Forest Dene

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The management and staff continue to demonstrate a commitment to providing good quality care at Forest Dene, which was also observed on the newly opened Dementia Unit.One hundred per cent of the feedback received from residents confirmed that they feel safe and comfortable in the home. There continues to be satisfactory arrangements for meeting the nutritional needs of individuals, although two residents expressed the view that it is an area that could be improved. The management and staff also have and maintain positive links with residents` relatives and they (residents) are pleased with this. What has improved since the last inspection? What the care home could do better: Ensure that an appropriate monitoring system is in place for the safe management of drugs in the home. Advertise the availability of `night bites` (See Standard 15) for the benefit of all residents. Review the staffing levels at peak times on the morning shift, involving staff where possible in the process. Staffing appraisals need to be carried out consistently and on an annual basis. Comply with all requirements set by the Commission within the specified timescales. CARE HOMES FOR OLDER PEOPLE Forest Dene 48 Hermon Hill Wanstead London E11 2AP Lead Inspector Stanley Phipps Unannounced Inspection 8th January 2008 10:30 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 Forest Dene DS0000067415.V356928.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. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Dene Address 48 Hermon Hill Wanstead London E11 2AP 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) 020 8989 2311 020 8530 2822 www.sanctuary-care.co.uk Sanctuary Care Ltd Juliette Anna Oates Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (30) of places Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 elderly people who may have physical or sensory disabilities or mental frailty related to the ageing process but who are not mentally ill within the meaning of the Mental Health Act 1983. To include one named person under 65 years of age Date of last inspection 14th July 2006 Brief Description of the Service: Forest Dene is a care home registered to provide personal care for forty elderly people, ten of which receives specialist Dementia Care. It is owned and run by Sanctuary Care. The home is located on Hermon Hill, Wanstead in the London Borough of Redbridge. It is close to Snaresbrook and Wanstead underground stations and main road routes to Central London and Essex. It is approximately half a mile from Wanstead High Street, which has a selection of amenities including shops, a library, chemist, post office, places of worship, restaurants and public houses. Forest Dene comprises 4 units, set over three floors - a lower ground floor (Ashgrove- containing the Dementia Unit), ground floor (Beechgrove) and first floor that houses Pinegrove and Highgrove. There is lift access to all floors. There are bedrooms, bathrooms, lavatories and communal lounges on all floors. The main dining room is on the ground floor. None of the bedrooms have en-suite facilities, but all have hand basins. Laundry facilities are sited on the first floor. All rooms are connected to an emergency call system. The facilities also include a hairdressing room with an on-site hairdresser available to service users and a medical room. The home has a domestic sized garden with a paved patio area. The home is staffed on a twenty-four hour basis in providing care and support to elderly service users. Fees are charged at £480.82 and do not include hairdressing priced (variable); newspapers and toiletries (variable prices), private chiropody (£10.00). The home’s statement of purpose is made available to residents on request and Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 5 a copy is kept in the staff office. Each resident is given a copy of the home’s service user guide, once admitted to the home. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 6 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. The inspection was carried out on the 08/01/08. It was unannounced and a key inspection of the service, which meant that all the key minimum standards for ‘Older Persons’ were assessed, as well as all standards for which a requirement was made, following the last inspection. The assessment also considered information provided in the Annual Quality Assurance Assessment (AQAA) by the registered persons, and a report produced by an; ’Expert by Experience’ based on her findings on the day of the site visit (8/01/08). The ‘Expert by Experience’ is one of the tools introduced in 2007 as part of the Commission’s inspection methodology. An assessment of medication practice, activities, menus, all records required by regulation, resident’s care plans and the environment was undertaken. Over the course of the inspection discussions were held with several staff, three residents, three senior staff members, the deputy and the registered manager. The inspection considered comment cards completed by staff, residents alongside verbal feedback that was provided by external professionals and relatives. The inspector also observed by invitation, the processes involved in two meetings during the course of the visit. The inspection found that residents living at Forest Dene were receiving a good standard of care, which could be attributed to the compliance with the national minimum standards and its associated regulations, as well as meeting all the requirements that were made in the last inspection report. It must be stated that the residents and staff made a significant contribution to the inspection process for which the Commission is grateful. There was a positive atmosphere throughout the home, particularly noticeable between the two groups. In concluding, Forest Dene has a very welcoming appeal. It has a relaxing, easy and calming feeling. Both staff and service users appear to be happy, relaxed and unhurried. There appears to be always time to stop and chat or just ensure that the resident is okay. What the service does well: The management and staff continue to demonstrate a commitment to providing good quality care at Forest Dene, which was also observed on the newly opened Dementia Unit. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 7 One hundred per cent of the feedback received from residents confirmed that they feel safe and comfortable in the home. There continues to be satisfactory arrangements for meeting the nutritional needs of individuals, although two residents expressed the view that it is an area that could be improved. The management and staff also have and maintain positive links with residents’ relatives and they (residents) are pleased with this. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forest Dene DS0000067415.V356928.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 Forest Dene DS0000067415.V356928.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): (1,3,6) People who use 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. Service users have updated information, which they could rely on in making a decision to live at Forest Dene. Their needs are assessed in detail prior to admission to determine the suitability of the home in meeting them. Intermediate care is not provided at Forest Dene. EVIDENCE: An updated statement of purpose and service guide was available for inspection and there was evidence that one of the most recently admitted service users had access to it. It was in a print that was suitable to the resident group and the audio version was in the process of being updated. The registered persons gave an undertaking that the document would be translated into other forms e.g. an alternative language, to meet the specific communication needs of residents. Relatives and residents spoken to were satisfied with the quality of information provided to them. One resident commented; “It was my children who look for s home and I think they had enough information about the home”. One hundred per cent of the resident feedback received indicated that they had enough Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 10 Quality This jud this serv information about the home, prior to deciding to live there. In many cases they had the assistance of relatives and/or social workers. As part of case tracking, the files of three of the most recently admitted residents were assessed, and it was conclusive that they all had a comprehensive assessment carried out prior to their admission. The registered manager or a suitably qualified senior member of staff usually carries out the assessments to ensure that a consistent approach is undertaken. There was evidence that summary assessments were obtained as part of the admissions process to ensure that a detailed picture of needs is acquired, before a decision is taken. Residents spoken to described the admission’s process as being unrushed, which gave them reassurance that the home would be sensitive to meeting their needs. At Forest Dene Intermediate Care is not provided and the registered persons are aware that if they intended to, that they would need to be review the staffing levels, statement of purpose and most importantly, the environment to ensure that it would be fit for the purpose. Forest Dene DS0000067415.V356928.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): (7,8,9,10) People who use 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. Residents are assured that their personal, social and healthcare needs are well provided for, although some improvement is required to the support given with medication. Staff actively promote their privacy and all residents are pleased that they are respected at Forest Dene. EVIDENCE: Three service users’ plans were examined and they included those of the most recent residents, as well as residents who were part of case tracking. There is a good system of service user planning in the home in that they generally detailed the health, personal and social care needs of residents. Where possible residents and their relatives are involved in the processes and the care plans were reviewed at regular periods. What was positive is that when a need changed, the plan reflected this change. From observation and from talking to staff, it was clear that care plans were used as working tools from which the care and support is delivered. It was also observed that the care plans were linked to individual risk assessments in promoting the safety and independence of residents. Approximately eighty per cent of the feedback received indicated that residents were happy with the Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 12 care and support that they received living at Forest Dene, most of which is well documented in the care plans. There was evidence that all residents are registered with a GP and that they receive regular input from the dentist, opticians, chiropodist and where required the audiologist. Where required, the services of the district nurse and continence advisor were also accessed. Good records were held on all interventions made by healthcare professionals. The home also maintained good records on: nutritional screening, weight and blood sugar monitoring. Staff spoken to demonstrated a good understanding of the healthcare needs of service users, which is coordinated through a key worker system and linked to the care plans for each individual. Feedback received from residents and relatives overwhelmingly indicated that they receive the medical support they needed, which is positive. Some of the residents spoken to were also aware of their medical problems, which demonstrated not only their understanding of them, but also, their involvement in maintaining a healthy lifestyle. This has been identified a strong area of the homes operations. An integral part of promoting healthcare involved supporting residents with various types of medication, in which staff were involved. It was noted that clear policies and procedures were in place for the administration of medication including its self-administration. All staff handling medication received appropriate training to enable them to so do and this included training in a newly introduced system (Boots Monitored Dosage System). The system had been introduced approximately two months prior to the inspection and upon a thorough assessment of its application several practices needed improving, which compromised the safety and well being of residents. Some of the areas included missing signatures on the medication charts and several cases in which an audit trail of medication could not be accurately carried out. A detailed discussion ensued collectively with up to three team leaders and the registered manager regarding the areas of weakness. This was necessary as the home from the previous inspection report, needed to demonstrate improvements in the way they supported residents with their medication. As a result of the findings the registered manager acted swiftly and arranged training for the team leaders (15/1/08), carried out an investigation into the failings and provided the Commission with the findings and proposed actions, and developed a monitoring tool with the aim of carrying out monthly medication audits. It is imperative that these monthly audits are carried out to ensure improvement in the way medication is managed as well as improving the quality of support that is provided to residents. Medication storage and disposal was managed effectively. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 13 During the course of the inspection the staffing engagement with residents indicated that the residents were respected and their privacy upheld. Service users were observed receiving personal support from staff and their privacy and dignity was preserved in all cases seen. Staff were spending most of their time engaged with residents, addressing them by their preferred names to which they were quite responsive. The staff demonstrated a caring, helpful and friendly attitude towards residents and worked in line with their induction standards and the General Social Care Council’s Code of Conduct. From assessing the comments made by residents and their relatives, most were extremely happy with the level and quality of the staffing input into the care and support that is provided at Forest Dene. Sound arrangements are in place should residents need to be seen in private and residents commenting were also pleased with this. This is a positive of the home’s operations. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 14 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): (12,13,14,15) People who use 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. Residents enjoy a range of activities at Forest Dene, which is in line with their social, recreational and religious interests. They also enjoy maintaining strong links with family, friends and the local community. Their lifestyle is enhanced by the enabling choice in their lives and the provision of meals that are suited to their needs. EVIDENCE: From observation and the wide range of feedback received during the inspection it was clear that all residents were given a choice in relation to their preferred interests including religious observance, meals, personal and social relationships, activities and routines in the home. This follows on from an individual assessment for each resident. An activities coordinator is employed Monday to Friday and leads the way in ensuring that residents are stimulated in a manner that is best suited to them. An activity programme is displayed around the home, although at times some residents were not sure as to what was on for the day. While neither the ‘expert by experience’ nor the inspector observed a structured activity during the course of the inspection, it was reported that structured activities take place in the morning in the Dementia Unit and in the afternoons on the main area of the home. A discussion with the activity Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 15 coordinator indicated that she was fully aware of the preferences, strengths and limitations of each resident. There is an activity folder, which reports on the participation of each resident and this was well maintained. Internally, residents benefit from playing Giant Scrabble, Ludo, indoor bowls, an exercise group, reminiscence, and monthly entertainment. They also benefit from external outings and e.g. visiting the Eagle Pub. A van is reportedly available on Fridays for the benefit of residents’ outings. Residents were enthusiastic about the provision of the activities, although some of them did, some of the time, need persuasion or encouragement to participate. Some of the residents said that they had various trips out of the home accompanied by family members. A hairdresser visits Forest Dene regularly and ensures that the ladies have their hair done and the gentlemen have their haircuts. A variety of religious services are held at the home on a regular basis. Feedback received from both written and verbal sources indicated that residents enjoy the flexibility of the activity programme and the fact that they have the right to opt out when they feel like. The home has the capacity to enable residents to have conversations in private and undisturbed. Some were observed using this option, whilst others preferred to meet their visitors in the open. There is a clear and open visiting policy and every relative spoken to, commended the home’s management regarding the way in which the home facilitates visitors. Friends of residents were also interviewed and they shared the same sentiment. Moreover, they viewed the visiting arrangements, as having a positive impact on residents’ lives. A good example of the homes commitment could be taken from the fact that, residents’ wishes and that of their family are taken seriously. This ensures that a sense of fulfilment for both groups is achieved. There was evidence that residents were given support to exercise choice and control in their lives. In speaking with five different residents, they were all very chatty, spoke of their families, their earlier occupations, the earlier years of their life as well as their present lifestyle. Bedtimes appear to be flexible and generally instigated at the resident’s request and they seemed very comfortable with this. One resident preferred to remain in their own bedroom, having meals delivered there. This resident was also very chatty and happy with the choice of lifestyle despite having limited vision and hearing. None of the residents appeared sad, unhappy or dissatisfied in any way and it was clear that they had a range of choices in various aspects of their lives and the home in which they lived. Information on advocacy services is widely available to all residents. This is a strong area of the homes operations. The ‘Expert by Experience’ was invited to have lunch with the residents which was accepted. The dining room is a large, airy and pleasant room overlooking the terrace. The tables were set for four people and a choice of menu was Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 16 available. Several of the residents ordered salmon, as did the ‘Expert by Experience’ and this was delicious. Unfortunately the salmon portion served, had a great number of bones throughout. One of the residents sitting at the table with the ‘Expert by Experience’ had the same experience but it did not seem to present any problem. The resident, although over the age of 90, carefully removed all the bones and enjoyed the fish. Another diner chose the tomato and cheese omelette and this was well presented, looked appetising and obviously thoroughly enjoyed. During a discussion with a member of staff, she informed that any special dietary needs would be established at the initial assessment and catered for accordingly. In a brief interview with the head chef, he demonstrated a sound knowledge of the residents’ needs. During lunch, because the dining room overlooks the terrace, squirrels could be seen hopping along the terrace railing. A choice of dessert was available and looked very tempting. Residents were asked if they required more drinks, additional ice cream, which meant that there was both choice and availability of food in the home. One resident required assistance with eating the food and this was administered very smoothly and easily, making the mealtime pleasant. It was noted that several improvements were carried out to the kitchen, making meal preparation safer. One area that could be enhanced is the advertisement of the availability of ‘night bites’ i.e. light snacks, sandwiches following the evening meal. This is to ensure that all residents as and when they require, know what is available to them. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 17 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): (16,18) People who use 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. Residents and their relatives are assured by the management’s handling of complaints, that their concerns would be addressed as and when they arise. There are sound protocols and procedures in place for safeguarding adults at Forest Dene. EVIDENCE: Feedback received from residents, overwhelmingly indicated that they were aware of both their right to, and how to complain. Relatives spoken to echoed a similar sentiment. This does not mean that some residents prefer to say very little if they unhappy, however both the management and staff exhibit a positive attitude towards complaints. The culture in the home is one in which complaints are seen as a way of improving the service. Staff take an active part in ensuring that complaints are recorded, and there was evidence that outcomes were also recorded. The complaints procedure is in a format that residents and their relatives could identify with, and relate to. There were two matters regarding the safeguarding of adults at Forest Dene. Both matters were handled in line with Local Authority’s Safeguarding protocol and the home’s safeguarding guidelines. All staff interviewed knew how to respond in the event of an alert and there was evidence that this issue is discussed with staff in various forums. The management team is also aware as to when an incident needs to be referred to the Local Authority as part of the local safeguarding procedures. There was also an understanding of the boundaries when discussing incidents with external bodies. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 18 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): (19,21,24,25,26) People who use 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. Improvements to the various aspects of the environment now ensure that residents’ needs and their safety are prioritised. The facilities including toilets and baths are of a good standard. The personal spaces occupied by residents also meet their expectations and needs, which is special to them. EVIDENCE: Forest Dene is a well maintained home with light, bright and clean paintwork. The flooring is clean and “stumble-free”. It felt very safe to walk on without appearing too clinical. The furniture is very pleasant and, without giving a cluttered appearance, there are many chairs scattered around for a quick rest. Leading from the dining room on the ground floor is a large decked area forming a balcony/terrace. This is very pleasant and will be put to good use during the warmer weather. It should be a very nice sunspot. A very large canopy (recently installed) can cover part or the majority of the area, if shade is required. It was noted that improvements such as; fitting a new ventilation system, replacing the dishwasher and fitting a door stop behind the laundry door, now ensures that the home is more fit for its purpose. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 19 Records viewed indicated that the home was compliant with environmental health requirements and the local fire safety standards. Generally the home was in a good state of repair and residents were observed comfortably and safely accessing various parts with and without staff support. Rails and other aids in baths were sited to promote the safety of residents. There is a designated lounge for any of the residents who may wish to smoke cigarettes. Only one resident was using it at the time of my visit but appeared to be quite content, watching television. There are two further very comfortable lounges on the ground floor, one of which contains a large flat screen television, which appeared to be a general meeting place for the majority of the residents. Toilets and bathrooms remained strategically located on both floors of the home and they were maintained to a good standard. There is only one shower with a cubicle that has a very high plinth to negotiate and is quite compact. At present this is not particularly easy for elderly residents to use, even with assistance but the room is large enough to cope with improvements that are scheduled. The plan is to remove the shower cubicle and provide a wet room, which will be much easier for both residents and staff. Ancillary staff is employed to ensure that they are kept in a hygienic state. Fixtures and fittings were secure and designed to promote the safety and independence of residents. Although none of the bedrooms have en-suite facilities, they are of a fairly good size. Residents, if they wish to have any of their own possessions and furniture, are able to do so, with the result that each bedroom has an individual, personalised appearance. Most of the residents were quite proud of their bedrooms, which were maintained to a very good standard. Having toured the building it was clear to see that adequate systems were in place for hot water controls, heating and lighting, which were well within acceptable and safe limits. Residents could have their room temperatures adjusted to suit their individual needs. All rooms have a source of natural lighting and ventilation throughout the home was quite good. Emergency lighting is cited throughout the home and good systems are in place to control the risk of Legionella. The home was clean, tidy and free from offensive odours. An infection control policy is in place and staff are taken through this as part of their induction training. Hand washing facilities are cited throughout the building and the arrangements for laundering soiled linen were excellent as there are now two sluice rooms. The laundry floor is impermeable and staff working in this department, were adequately trained to so do. The home complies with environmental standards and this ensures that residents are safe. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 20 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): (27,28,29,30) People who use 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. Residents receive a good standard of care from a team that is motivated, skilled, trained and, in adequate numbers to meet their needs. Their safety is also assured by the home’s robust recruitment practices and they receive care and support from a team that is generally well supported. EVIDENCE: Approximately sixty per cent of the feedback received from the residents indicated that staff were always available when they needed. Up to thirty percent expressed the view that staff are usually available when they are needed with ten percent stating that they are only sometimes available. From an examination of the rosters and the observations carried out on the day of the inspection, the staffing numbers were adequate to meet the needs of the resident group. This conflicted with sixty-six per cent of the staff team stating that the staffing levels, particularly in the mornings needed to be increased. They also shared their experience that the team leaders/duty officers, though reflecting in the daily numbers, do not offer the quality of cover required at peak times on the floor. Given the feedback from staff and residents, it would be appropriate to ask the registered persons to review the staffing levels in the mornings. It must be said that there have been low levels of complaints and incidents over the last year. A handyman is on site for up to four hours daily along with the provision of catering and laundry staff. It was therefore difficult to conclude that the Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 21 staffing levels were inadequate. More importantly the registered manager was able to demonstrate, where staffing levels have been adjusted to meet the changing needs of residents. In essence, residents have been supported in what could be described as a fairly safe environment. From examining the training records, it was observed that over seventy per cent of the staff had achieved an NVQ level 2 in care, which exceeds the national minimum standards. In essence most of the staff team had a sound understanding in the provision of good basic care, which was translated into practice during their engagement with residents. This is indeed positive as an outcome for the service users living at Forest Dene. The recruitment files of three of the most recently recruited staff were examined and it was clear that the home’s management was operating in line with their procedures. Detailed application forms were appropriately checked there was close monitoring of references and appropriate Criminal Records Bureau checks to ensure the safety of residents. All staff had the experience of being interviewed and were not employed unless the registered persons were satisfied that they are fit to work with the service user group. All staff had a statement of their terms and conditions, as well as a copy of the General Social Care Council’s (GSCC) code of conduct – which details the standards expected when working with residents. All staff were in receipt of an induction and the most recently recruited had theirs in line with ‘Skills for Care’ Induction Standards. Staff also had the benefit of foundation training as well as training that enabled them to improve and achieve outcomes for people using the service. There is a training and development needs analysis for staff, which identifies what is needed and the priority, which is based on delivering a safe service. A training plan is in place and, apart from key refresher areas, included; – fire, safeguarding adults, medication, infection control, health and safety and further NVQ training. Feedback from relatives and residents supported the view that staff worked well in relation to meeting residents’ objectives. It was positive to see the level of confidence among the staff team throughout their engagement with residents. Through observation it was determined that the residents had a good relationship with the staff and felt very comfortable with them. It should also be noted that the staff have demonstrated their commitment to the service during the refurbishment works that took place over the last year 2007 at Forest Dene. Feedback received from some members of staff raised a concern over the lack of remuneration for unsociable hours, which is something the registered persons may wish to look into. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 22 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): (31,33,35,36,38) People who use 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. Residents benefit from a home that has good management practices, which positively impacts on the quality care they receive. Quality assurance systems and a well-supported staff team provide positive outcomes for people who use the service. Regular monthly provider monitoring visits, good financial practices as well as sound health and safety practices ensure that the best interests of service users are well provided for. However, an improvement in the frequency of staffing appraisals is required to enhance the overall level of service provision at Forest Dene. EVIDENCE: The registered manager despite being registered with Commission in 2007 has been working with the resident group for a considerable period of time. During that time she has developed a sound understanding of the needs of the resident group. She has been the deputy manager prior to taking up the post as manager and has embarked upon her NVQ Level 4 Award in Management – Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 23 some seven months ago. She is committed to the resident group and has the commitment of the staff team. All the residents spoken to thinks well of her and she has a commitment to equality and diversity as it applies to her service. She has been observed chairing team meetings and, dealing with a staff dispute and both events were handled professionally. Residents and staff find her approachable and so this benefits the service as a whole. There were good mechanisms to promote quality assurance in the home and the registered manager is proactive in ensuring that systems are in place to identify development areas and bring about change. A self –audit was carried out in February 2007, along and a financial audit in June 2007. An annual development plan is in place and is linked to the business plan for the home. Regulation 26 monitoring visits have been carried out regularly and quarterly residents’ surveys have been carried out. Policies and procedures were updated. In essence the registered persons have ensured that action has been taken to maintain and improve the quality of services provided at Forest Dene. The financial and accounting interests of service users were satisfactorily safeguarded at Forest Dene. Records were assessed where monies are handled on behalf of residents, and they were found in order. A random check on balances held for residents was also satisfactory. Financial guidelines were in place to direct how all finances are to be handled. An accurate audit trail was available in relation to how the residents’ financial interests are promoted and a secure facility is available for storing the residents’ valuable possessions. This is a sound area of the home’s operations. Staff were positive about the support and direction they received at the home. They were generally regularly supervised, although they were not having their appraisals annually. This allowed them opportunities to get feedback on their work, make contributions towards developing the service and their professional development. Staff also had the benefit of attending regular team meetings and were able to informally approach the manager or her deputy, with personal or work-related issues. It was clear adequate systems were in place to ensure that staff are monitored and given good support in providing quality outcomes for people using the services. Improvements in the frequency of appraisals would enhance the quality outcomes for staff and by extension – the residents. An updated health and safety policy is in place for staff to follow in promoting the safety of residents. They also receive training to ensure that theory is put into practice and good arrangements such as random monitoring are in place to enable this. The health and safety files were assessed and found to be in order e.g. PAT testing (April 2007), fire drills, call point testing and Legionella monitoring. Health and safety signs were appropriately posted and arrangements for infection control were satisfactory. Risk assessments were also in place for first aid, fire, food hygiene, moving and handling and infection Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 24 control. Good arrangements were in place for gas and electrical safety, as well as for the lift maintenance and other equipment used in the home. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 25 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 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13 Requirement The registered manager is required to ensure medication is regularly monitored to ensure residents’ safety and well being at all times. (See Standard 9). The registered manager is required to ensure annual appraisals are carried out for all staff. This is a repeated requirement with a previous timescale of 31/12/06. Timescale for action 05/03/08 2. OP36 18(2)(a) 19/03/08 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 OP15 OP27 Good Practice Recommendations The registered persons should advertise the availability of ‘night bites’ for the benefit of all residents. The registered persons should review the staffing levels in at peak times in the mornings, involving staff where possible in the process. Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Forest Dene DS0000067415.V356928.R01.S.doc Version 5.2 Page 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. 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!