Care Home: Forest Hill House Nursing Home

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What the care home does well Forest Hill continues to provide a homely, caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal person centered way. This was evident in the way the care needs of people living in the home was recorded. The surveys we received indicated that people were very happy with the way they received the support and care provided by staff in the home. One survey stated `they are all very good,` and `they are marvellous I take part in the activities and go on outings.` Another survey stated `I am happy with the home and staff.` We saw that people living in the home could take part in a full and meaningful program of activities, people also said they enjoyed the meals that were provided and we saw that they could contribute to the menu by commenting in discussion with the activities organiser. The opinions of people living in Forest Hill are valued, as they can talk to the activities organiser about how they preferred things to be done. People`s rooms also reflected their personality with personal pictures, ornaments and furniture in place. We saw that training for staff was very important and that they were encouraged to obtain an NVQ qualification and assisted to keep up with current issues and care trends. Staff surveys indicated that they felt well supported eanbling them to provide a good level of care to the people living in the home. One survey said that they felt the manager was very approachable and supportive enabling them to meet both the physical and emotional needs of people in the home. What has improved since the last inspection? The manager confirmed that they had considered all the issues raised at the last inspection and worked hard in meeting the comments raised. This meant that care plans are person centred with appropriate guidance for staff to follow. Equipment being used such as bedrails are covered with a clear risk assessment and an agreement signed either by the resident or a relative responsible for making decisions on their behalf. Care plans also indicate clear protocols on the use of PRN (as required) medication. When we looked at the recruitment procedures we saw that all checks to protect people in the home were now being carried out. What the care home could do better: Following this inspection no requirements were made. We made one best practice recommendation which refered to the recording of medication we found that handwritten entries on the medication chart had not been signed or witnessed by a second member of staff this meant that a mistake could be made when copying a prescription putting people at risk of a medication error. We also discussed with the manager the need to ensure staff do not use abbreviations or Latin when recording medication by hand on the charts. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Forest Hill House Nursing Home Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Juanita Glass     Date: 0 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Forest Hill House Nursing Home Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT 01202631741 01202632742 foresthilloffice@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Bay Care Homes Ltd care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 36 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Forest Hill House is set in a rural area with spacious wooded grounds and a large gravelled parking area. Forest Hill House is registered as a care home with nursing for people over the age of 65. It offers accommodation on three floors for 36 elderly people with 18 single rooms and 9 double rooms. Many of the rooms have en-suite facilities and there are sufficient communal W.Cs and bathrooms. There is a passenger lift to all three floors and a stair lift to the first floor. There are a variety of aids and adaptations around the building to allow residents to move about more independently. There is a large sitting room, a Care Homes for Older People Page 4 of 26 Brief description of the care home dining room and a conservatory, which leads out on to a small patio area with a pond and raised flowerbeds. There is a bird table and a variety of outdoor seating arrangements. The current fees for this home are available on request from the home manager. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day and a total of six hours were spent in the home. To gather enough evidence to support our judgements for this inspection, We The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. Once we had received this information we carried out a visit to the home and spoke to Care Homes for Older People Page 6 of 26 people living there, the staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, the service records and health and safety. Following the inspection we looked at surveys returned to us by people living in the home and people with an interest such as relatives, social workers and GPs. We received six surveys from people living in the home some of these had been completed by relatives on their behalf and six from staff working there. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from adequate written information a chance to visit the home and a full assessment of their needs. This means they can make an informed decision before moving in and their needs are fully met. Evidence: We the Commission looked at a copy of the homes Statement of Purpose and Service User guide. They were readily available in the home and provided immediately. We saw that the Statement of Purpose was well written and contained all the information a person would need to tell them about what care the home can and cannot provide. It also states clearly the fees and what they pay for with a list of extra charges clearly mentioned. The document also makes a statement about meeting peoples needs whilst repecting their religion, culture, race, sexuality and sexual orientation. We spoke to the manager about how she would assess a person who wished to move Care Homes for Older People Page 11 of 26 Evidence: into the home. She said she visits the person either at their home or in hospital. She talked to them, a relative or advocate and staff at the hospital or a social worker. She would also look at existing care plans for the person. We then looked at the records held in the home for two people who had not lived there very long. They both had completed pre-admission assessments and community or hospital care plans. We then spoke to people living in Forest Hill however they were not able to comment on the experience. People wanting to move into Forest Hill can visit and spend some time there to meet other residents and staff. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the home is really the best placement for them. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 Forest Hill benefit from personal and specialist health care support that is provided in a person centred way respecting their privacy and dignity. They benefit from and are protected by the homes policies and procedures for the administration of medicine. Evidence: We looked at the care plans for four people living in Forest Hill. All care plans were recorded in a person centred way. They showed us that staff had a clear understanding of the way to record the personal likes and dislikes of the resident in their care. All the care plans we saw reflected this approach with clear guidelines for staff about peoples personal likes and dislikes. Staff spoken to said they knew each individual, their preferences and when they prefered to be helped or left alone. We observed staff chatting with residents in a friendly and relaxed way. People we spoke to said they were happy with the way in which they were cared for. One person said they really liked living at Forest Hill and especially liked the staff who worked Care Homes for Older People Page 13 of 26 Evidence: there. All the care plans we looked at included appropriate risk assessments and showed signs of regular review. Care plan reviews also reflected the changes in peoples lives showing a continuity of care. People living in Forest Hill have access to healthcare specialists and care plans showed that the district nurse or a specialist nurse could be consulted when the home felt they needed some expert advice. People were also helped to attend outpatient appointments, the dentist, optician and chiropodist. Forest Hill has very clear policies and procedures for the receipt and administration of medication. We looked at the records kept by the home for medication and the way that medication was stored. We saw that all procedures were being carried out correctly, however we advised that handwritten medication charts needed to be signed and witnessed to protect people from the possibility of an error in transcription. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from the development of meaningful activities which recognises their diverse needs, enabling them to maintain some control over their lifestyle. They benefit from continued contact with family, friends and the local community. A well-balanced menu means people benefit from a healthy nutritional diet. Evidence: We discussed the provision of activities in the home with the manager, staff and some of the people living there. We saw that there was a very clear record being kept to show that people have plenty of opportunities to join in an activity. One person we spoke to said that that there was always plenty to do another person said they were never bored. The home has a dedicated activities organiser who works Monday to Friday arranging and providing a full activities package that people want to take part in. The activities organiser holds regular resident forums when they discuss meals, menus and themed days, residents suggested a Valentines theme and a favourite foods day. Themes have been planned around staff cultural backgrounds talking about their traditional clothes and food. Care Homes for Older People Page 15 of 26 Evidence: We saw evidence to show that people took part in trips out in the home minibus, they had painted bowls for bulbs to give as presents to their relatives and friends, they would be helping to plant the hanging baskets for spring and took part in bingo, quizzes, shopping trips and reminiscence sessions. We also noted that some people enjoyed using a computer game that enabled them to play bowls or go fishing. People we spoke to also praised the standard of food very highly more than one person said that the meals they received were of an excellent standard. We talked about lunch on the day of our visit and they said they had enjoyed a Sunday Roast. We saw that the meal time was unhurried and was a social occassion. Menus showed that people received a nutritious wholesome choice which included fresh fruit and vegetables. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the procedures to follow to protect people from abuse. Evidence: Forest Hill has a very clear complaints policy and procedure, which is easy to read. It shows a clear timeline and action to be taken if someone wishes to raise a concern or complaint. A copy is clearly displayed in the hall, and can be provided in large print if necessary. People we spoke to said they knew who to approach however did not comment further on raising issues. The manager keeps a full record of all concerns, complaints and compliments they receive. All staff have attended training in safeguarding vulnerable adults and they are all aware of the homes policies and procedures, Staff spoken to knew what procedures to follow and who to contact if they suspected that a person living in the home was at risk of harm or abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 benefit from a comfortable, well equipped and homely environment, which is well maintained and decorated. They have access to well maintained garden areas including a disabled garden. People are protected by staff awareness of appropriate infection control guidelines. Evidence: We carried out a tour of the home; we looked in some peoples rooms. The home is well furnished in such a way that people living there can chose where they wish to spend their time either in their room, the lounge or a conservatory area. All areas of the home were clean and tidy and people we spoke said the home was always clean. The furniture and fittings are of a good standard and communal areas are pleasantly decorated. We saw rooms that were full of personal possessions reflecting the persons life and family. People we spoke to said they liked their rooms. A programme of re-decoration is followed as and when rooms become available. The home showed a good standard of housekeeping and no offensive odours were Care Homes for Older People Page 18 of 26 Evidence: apparent. The manager and staff showed a clear awareness of infection control policy and procedures and the manager confirmed that she can obtain guidance from outside agencies if required. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from and are protected by the staffing levels and skill mix of staff in the home. The homes recruitment procedures and staff training further protect people from the possibility of abuse. Evidence: The staffing rota showed that there is always enough staff in the home with the right skill mix to support the diverse needs of the people living in there. They also showed that staffing is flexible so that extra staff can be bought in to cover extra busy times such as activities or trips out. People spoken to did not comment on staffing levels one person did say that there were plenty of people about. We observed adequate staffing levels on the day of our visit and staff were not over stretched providing care in the home. The manager confirmed that staff are encouraged to obtain an NVQ Qualification in Health and Social Care. This was evident when 55 of their staff had obtained a level two or above qualification whilst others were attending training. Staff spoken to said they felt well supported in attending training relevant to the needs of the people in their care. Records showed that staff had all attended mandatory training as well as training that is necessary to provide a good level of care to the people living in the home. We saw evidence of training attended by both qualified and care staff enhancing Care Homes for Older People Page 20 of 26 Evidence: their understanding of the specific needs of people such as Dementia Care and Understanding the Mental Capacity Act. We also saw that the manager provides staff with information to support people in the home such as CSCI Equality Matters and In Focus publications as well as My Home Life. The home also provides work placements for student nurses whilst they are doing their community placement this helps all staff to keep up to date with current trends. Forest Hill has strict policies and procedures for the recruitment of new staff. The personnel files for two people who had recently been employed showed that the manager follows these guidelines as all the relevant checks such as references and a CRB (Criminal Record Bureau) check had been completed before the person started work. This protects people from possible harm or abuse. All new staff then follow a concise induction programme which follows the Skills for Care guidelines. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well run home with an appropriately qualified manager and supervised staff. The home does not manage residents finances. Both people working and living in the home are protected by robust health and safety procedures. Evidence: The Registered Manager has 20 years experience in the care of the elderly the last 16 years in the role of manager. She is a Registered Nurse and has attained the NVQ Level 4, Registered Managers Award in Management in Health and Social Care, she is also a qualified Moving and Handling trainer and the Adult Abuse Awareness trainer for Dorset County Council. The manager is currently studying for the Diploma in Teaching. People we spoke to did not comment on the management of the home however they indicated that could always talk to the manager if they wanted to. The organisation carries out a regular quality assurance process and the activities organiser enables people to be involved in the day to day running of the home by Care Homes for Older People Page 22 of 26 Evidence: holding meetings and one to one duicussions with people living in the home. The manager confirmed that the home currently does not directly handle residents financial affairs. Staff personnel files showed that regular supervision is planned and carried out. Any training and development needs are identified and followed up where possible. Staff stated that they felt well supported by the manager and could approach her at any time. We looked at records relating to the servicing of equipment in the home. All the records were up to date and available for inspection, these included the COSHH records, which are guidelines for staff to follow if they spill, drink or are splashed by chemicals used in the home. These can also be provided in an alternative language if required. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly including the hot water checks. A review of the firelog showed all tests, training and drills were being carried out to the Dorset Fire Brigade guidelines. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The registered person needs to ensure that handwritten entries on the medication charts are signed and witnessed to prevent mistakes happening. Care Homes for Older People Page 25 of 26 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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