Care Home: Forest Home

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What the care home does well What has improved since the last inspection? The home has been decorated in part and new provided throughout all communal areas. An aid to enable residents to be appropriately supported when having their hair washed. It is also proposed that a designated hairdressing room will be provided with the extended facilities that are planned. Monitoring of drug fridge temperatures has been put in place. Updated staff training in medicines administration has been provided with documentation to assess competencies obtained from pharmacy. CARE HOMES FOR OLDER PEOPLE Forest Home 58 Swan Street Sible Hedingham Halstead Essex CO9 3HT Lead Inspector Diana Green Unannounced Inspection 29th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Forest Home DS0000017820.V367900.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 Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Home Address 58 Swan Street Sible Hedingham Halstead Essex CO9 3HT 01787 460361 01787 463870 foresthome58@btinternet.com 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) St Giles Homes Limited Mrs Tanya Jelley Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 34 persons) 6th June 2007 Date of last inspection Brief Description of the Service: Forest Home is a privately owned home situated in the village of Sible Hedingham. It is registered under the Care Standards Act 2000 as a Care Home to accommodate 34 older people. The building is a detached listed property, with a more recently built fourteenbed extension to the rear of the building. There is a driveway to the front of the property with car parking facilities and a large garden and patio area to the rear of the property. The local amenities include a post office, church, newsagents and a supermarket. Accommodation consists of 20 single bedrooms and 7 shared rooms, which are located on the ground and first floor. There is a passenger lift between the two floors. There are a number lounges and a large dining room with access to a patio area and the gardens. Fees for the home range between £445.00 and £569.00 per week. The cost of hairdressing, chiropody, newspapers and toiletries is not included in the fees. This information was provided to CSCI on 29/07/08. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Forest Home DS0000017820.V367900.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 was an unannounced key inspection lasting 6.5 hours and took place on 29th July 2008. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA) and surveys distributed to residents, relatives, staff, and health and social care professionals. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the service’s strengths and weaknesses and how they will address these. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment and training, staff rotas and policies and procedures. The inspection process included: discussions with the registered manager, the administrator, four residents, four care staff, one relative and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry/sluice-room; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection. The registered manager and staff were welcoming and helpful throughout the inspection. What the service does well: Forest Home provides a secure environment that is well decorated and comfortably furnished and cleaned to a good standard. Residents are enabled to personalise their rooms with their own furniture and belongings. There are number of small lounges that offer residents with a choice of relaxing in a different environment that meets their needs for watching television, listening to music, reading, social interaction or activities. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 6 The standard of personal and healthcare is good and residents are enabled a choice in all aspects of their care and daily life. The standard of food is good with home cooking and choices well accommodated. Residents work well as a team and take time to talk to residents where time allows. The Quality assurance programme ensures regular consultation with resident, relatives and other stakeholders and appropriate action taken to improve services. When asked what do you think the service does well, a relative told us ’keeping my x well and clean. Talking to x individually if x has any anxieties or a problem’. Another relative told us ‘décor, furnishings and varied choice of main meals. The menus are excellent’. What has improved since the last inspection? What they could do better: Assessment for activities could be improved to include each resident’s personal history. More outings could be provided. Religious needs should be assessed on admission and recorded with a plan of how these will be met. The manager should continue to negotiate with the local clergy to provide a religious service for residents. Nutritional risk assessment needs to be more robustly recorded with weights recorded on admission. Further staff training in care issues could be provided, for example in dementia awareness. Infection control standards are generally good, however some staff practices were unsafe (sluicing laundry) and there was a lack of provision of equipment (alginate bags). Hand washing facilities also need to be provided in all areas where personal care is provided. Radiator covers and window restrictors should be fitted as part of risk assessments. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 7 Medication policy and procedures need review and there are some issues that need to be addressed in terms of documentation and monitoring of temperature storage. The complaints procedure needs to include LA details as placing authority 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 Home DS0000017820.V367900.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 Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 1, 3, 5 & 6. People planning to move to Forest Home can expect to be well informed, and to have their needs fully assessed prior to moving in to the home to ensure they can be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose and service user guide that met the required regulations. However the statement of purpose was in need of review as it referred to activities such as musical movement that were no longer provided. The registered manager explained the admission procedures during the site visit. This included liaison with the hospital placement team, resident, family and hospital staff (where relevant) and obtaining a needs assessment (com 5) form via email. A pre-admission assessment visit was undertaken either at Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 10 home or hospital where possible to ensure resident’s needs could be met at the home. We were told that the manager considered specific needs, for example infections, which may be a risk to other residents before agreeing admission. Care management assessments were seen on the care records viewed. A sample pre-admission assessment form was seen, and included all elements of need as indicated under this standard. The manager stated that prospective residents are invited into the home for a day and can stay overnight when copies of the statement of purpose and service user guide are also made available to them. A trial period of four weeks was offered to them at which time a review was undertaken. The home does not provide intermediate care. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled standards 7, 8, 9, 10. People living at Forest Home can expect to have their health and personal care needs met through care planning that is closely monitored and regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents’ care files were viewed including one resident that had been admitted as an emergency placement. All files contained a pre-admission assessment form developed by the home. The form was not completed for the emergency placement, although full details were present on the needs assessment provided by the social worker. The pre-admission assessment form for a second resident contained a brief record of discussion with the resident rather than an initial assessment of needs. The local authority needs assessment (com 5) form was also incomplete. We were told that they experienced problems in obtaining full information from social workers requiring home staff to contact them for further details. The manager told us Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 12 that she had to provide cover for staff sickness and leave and had experienced problems in completing information for recent admissions. This was confirmed from the remaining records viewed which contained full assessment details. Completed pre-admission assessment forms were present of the two remaining files. Additional individual assessments had been completed in regard to specific needs (e.g. risk of falls, moving and handling, continence, nutrition, skin condition, etc.) and regularly reviewed. The records included evidence that nutritional intake was usually recorded on admission and weight monitoring undertaken two weekly with appropriate action taken to provide supplements as needed. However one resident not had a full assessment for nutritional needs or seen by GP since admission following being admitted in a state of neglect. Whilst it was evident from observation and discussion with the manager that appropriate care was being provided, this was not confirmed from the records viewed. A range of care plans were present on the care files viewed, and these contained a good level of detail of the action required by staff to help the person meet their needs. All residents looked well cared for. One resident told us ’they couldn’t do more if they tried’. The records confirmed evidence of good monitoring of health care needs with prompt referral to GPs and health care professionals and appropriate follow up action being taken. When asked ‘do you receive the medical support you need residents told us ’always’ and one told us ‘they always get the doctor if I need it’. The records confirmed that residents were enabled access to GPs, practice nurses, district nurse and chiropodists. A relative told us ‘I think my x is well looked after at Forest Home. The carers are all very nice and thoughtful’. The systems for administration of medicines were discussed during the site visit with the registered manager. The home had a medication policy and procedures that were available for staff guidance and access to the British National Formulary for information (dosages, contra-indications, side effects etc.) on individual medicines. However procedures were brief, had last been reviewed on 21/10/06 and did not include sufficient guidance for staff on for example, as required (PRN) medication, homely remedies or disposal etc. We were told that senior care staff administered all medication at the home and the records confirmed that all had undertaken recent updated medication training. There was no current list of staff names, signatures and initials available to identify those staff who were authorised to administer medication. Medication was supplied through a local pharmacy in dosset boxes and individual containers and appropriate ordering and disposal procedures were in operation, although the written procedures did not refer to this. Medication supplies were stored in two locked trolleys that were stored in the dining room and both were secured to the wall as required for additional security. Further storage was provided in a separate cupboard. A Controlled Drugs (CD) cupboard was also available that was located on the first floor. A CD register was in use for recording CD drugs, however entries did not include the name Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 13 and address from where drugs were received from or disposed to. The drug fridge was stored in the dining room and regular monitoring of refrigerator temperatures was undertaken ensuring that medication was stored within safe recommended levels. However there was no recording of room temperatures to also ensure these were within safe limits. The medication administration records and supplies for four residents were inspected. All medication was available as prescribed and the medication administration records (MAR) were well recorded with no omissions evident. During the site visit, staff were observed to be friendly towards residents and to treat them with respect. When asked ‘what do you think the service does well, a relative told us’ they are understanding and patient’. Another relative told us ‘Staff and management show exceptional kindness to all their residents’. Forest Home DS0000017820.V367900.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): Quality in this outcome area is good based upon sampled inspected standards 12, 13, 14 and 15. People living at Forest Home can expect to mantain contact with their family and friends and to have a lifestyle that satisfies their cultural expectations and needs but that could be enhanced by additional outings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities were organised by a designated care assistant who explained that activities included individual and group activities for example solitaire, reading, nail manicures, board games, skittles, quizzes, ball games and musical bingo. Entertainment was provided by an external provider approximately four times per year with Christmas party and carol singers arranged during the festive season. During the site visit ten residents were observed playing hoop-la and others were watching television, listening to music and reading newspapers and talking to care staff. We were told that there were no outings arranged although staff took some residents out in wheelchairs. However this appeared Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 15 to be limited. When asked ‘how do you think the service could improve’ one relative told us ‘maybe if carers had the time to take my x out for a walk (in a wheelchair)’. The home’s statement of purpose included the policy on visiting, including residents’ right to choose whom they saw. Several visitors were seen to come and go throughout the inspection. The home’s statement of purpose and service user guide referred to the arrangements made for residents to maintain their faith by representatives of different faiths attending the home as they had requested. However the care plans did not include details of residents’ individual faiths or the arrangements for meeting these needs. We were told that a vicar regularly visited the home for one resident but that the home had been unable to obtain services from the local church. Residents were observed to have some choice about their daily life in the home, especially in regard to where they spent their day, ate their meals etc. Many of the rooms seen were well personalised, showing that people could bring their own possessions into the home with them. The number of alternative options of meals provided for residents during the site visit was impressive, showing that their preferences were accommodated as far as possible. The menus viewed provided a varied range of meals with alternatives available and with seasonal variations and based on mainly homely type food. The cook explained that a full choice was offered including a cooked breakfast. Fresh vegetables were provided daily and cakes and pastries were home baked. The lunchtime meal was observed and comprised homemade beef burgers with chips and spaghetti followed by lemon mousse, bananas and custard. Several alternatives had chosen an alternative (ham salad, eggs with mashed potatoes etc). Bread and butter and drinks were observed being served at the table. Several residents were spoken with during the site visit and all said they had enjoyed lunch. When asked if they enjoyed the meals at the home, seven residents who completed surveys stated ‘usually’ and one resident stated ‘always’. A resident also told us’ I am a vegetarian and they always provide me with a lovely meal’. A relative who completed a survey told us that ‘the menus are excellent’. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 16 & 18. People living at Forest Home can expect to have their complaints listened to and acted upon and to be protected from abuse by policies, procedures, staff training and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that included the timescales within which complainants can expect a response. The procedure advised complainants’ of their right to refer to CSCI but did not provide details of the placing authority that have a legal responsibility for safeguarding residents placed under their arrangements. The procedure was included in the statement of purpose and displayed in the entrance of the home. Four complaints had been received since the previous inspection and the records confirmed all had been investigated in line with the home’s procedures and appropriate action taken. When asked ‘has the care service responded appropriately if you or the person using the service has raised concerns about their care? We received the following comment from a relative ‘I’ve never had a need to complain’. And ‘the manager is always available if we need to discuss anything’. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 17 The home had comprehensive policy and procedures for safeguarding vulnerable adults that had last been reviewed in October 2006. Local Essex procedures were available for staff guidance but the recently updated procedures had not been received and the manager agreed to follow this up. The records confirmed that all staff had received relevant training. There had been one allegation of financial abuse made since the previous inspection, which had been referred as required under safeguarding procedures to the local social services. Forest Home DS0000017820.V367900.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): Quality in this outcome area is good based upon sampled inspected standards 19, 22, 25 and 26. People living at Forest Home can expect to live in a clean, comfortable, homely and generally well-maintained environment but some health and safety risks may compromise their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were secure with a digital door lock used for access and a record of all visitors to sign on entry. A partial inspection of the premises was made that included communal areas, several bathrooms, a number of residents’ rooms and the laundry. Since the previous inspection new carpeting had been provided throughout all communal rooms and some re decoration had taken place. The home was clean and decorated and very comfortably furnished providing a homely environment for residents. The rear garden was enclosed, laid mainly to lawn and had a covered patio area with seating for residents. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 19 Ramps were provided and enabled wheelchair access. Four residents were observed engaged in conversation with each other and reading newspapers. Those spoken with said they liked to sit out and enjoy the garden in nice weather. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. The home had a passenger lift, chair lift and platform lift to enable access throughout the premises. There were grab rails, and aids in bathrooms, toilets and communal rooms to meet the needs of residents. Assisted baths and toilets were provided and the home was fully accessible to wheelchairs. Call systems were provided throughout all individual and communal rooms. Pressure relief equipment (cushions and mattresses) was observed on residents’ chairs and beds to meet their needs. However feedback from some staff indicated that there were insufficient adjustable beds provided to ensure they were able to safely move and handle residents. A recommendation has therefore been made to this effect. The records confirmed that all equipment including hoists was serviced as per manufacturers recommendations. Residents’ individual rooms were provided with heating and appropriate lighting that met the standard. There were systems in place for monitoring the temperature of water to ensure it provided close to 43°Centigrade. However not all radiators were covered as part of a risk assessment and not all windows were fitted with restrictors posing a potential risk to residents. The standard of cleaning of the premises was good with no malodorous smells. It was good to see that following lunch, staff thoroughly cleaned tables and chairs ensuring that no food debris remained. Hand washing facilities (liquid soap and paper towels) were provided in bathrooms and toilets but not in all areas where personal care is provided. Some bins used for disposal were open, rather than foot operated. The home had a copy of the Department of Health (DH) Guidance for Infection Control for Care homes for staff guidance. The home’s policy and procedures for infection control were also available for staff guidance. We were told that these had been reviewed following advice from the Clinical Nurse Specialist to ensure procedures for disinfection of equipment complied with current guidance. However staff spoken with confirmed that they were sluicing foul linen and did not have alginate bags as recommended for safe practice and to minimise the risk of infection. This was discussed with the manager who agreed to review the procedures to ensure staff followed recommended safe practice. The laundry room was medium/large and had two washing machines (one with a sluice cycle) and one drier that were in use. Forest Home DS0000017820.V367900.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): Quality in this outcome area is good based upon sampled inspected standards 27, 28, 29 and 30. People living at Forest Home can expect to have their needs met by caring staff that have been robustly recruited and received appropriate training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were 29 residents at the home. Staffing levels comprised one senior care assistant and four care staff. The registered manager was not on duty but attended the home shortly after the site visit commenced. The administrator, two domestic assistants, a laundry assistant were also on duty. The manager explained that maintenance is provided through the organisation and a maintenance person attended during the site visit. There was evidence from the staff rota that staffing levels were well maintained and from observation these seemed to meet residents’ needs. Information received in the AQAA stated that the home had 27 care staff of which 4 had NVQ level 2 qualifications or above which is 30 and less than the recommended 50 needed to meet the standard. A further 4 staff were working towards NVQ level 2 training. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 21 We were told that staff retention was good with a number having been employed at the home for some years. The recruitment files of two recently employed staff were inspected. Both had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and evidence of identification and photographs obtained before the individuals commenced employment at the home. The records confirmed that both staff members had received a statement of terms and conditions of employment. The manager reported that all staff received induction to Skills for Care Standards and this was also confirmed from the records viewed. The home had an established training programme. The training records were viewed and confirmed that since the previous key inspection training had been provided in fire safety, protection of vulnerable adults, infection control, moving and handling. When asked ‘Do the care staff have the right skills and experience to look after people properly? Two relative told us ‘always’ and another said ‘all staff appear to be well trained in how to deal with residents’ and ‘they have a knack for employing the right type of carer. All staff members are very kind and caring, nothing is too much trouble’. Forest Home DS0000017820.V367900.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): Quality in this outcome area is good based upon sampled inspected standards 31, 33, 35, 36, 37 and 38. Forest Home is well managed and run in the best interests of residents. The health and safety of residents and staff is safeguarded by the policies, procedures and practices at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager had worked at the home for some years. The AQAA informed us that the manager was working towards achieving a qualification at NVQ level 4. The training records viewed confirmed that some updated training had been undertaken (safeguarding adults, basic food hygiene, care plan training) in addition to manual handling, fire safety etc. since the previous key Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 23 inspection. There was evidence from discussion with the manager that she was experienced, knowledgeable and competent in her role. The home had a quality assurance programme that included consultation with residents, their relatives, staff and other stakeholders (e.g. district nurses, GPs, practice nurses, social workers). Surveys were distributed at six months intervals and the findings used to improve services. This was confirmed from the summary report and action plan seen. The administrator was appointee for one resident at the home. All other residents had a representative/advocate to manage their finances on their behalf. Personal allowances were held for some residents and were held in lockable facilities for safekeeping. Records of income and expenditure were maintained. Two residents monies were inspected: receipts were held and records maintained and all cash was confirmed as accurate. Records held on behalf of residents were kept up to date and stored safely in secure facilities in the office in accordance with the Data Protection Act 1998. Records viewed at this inspection included the statement of purpose, the service user guide, medication records, care plans, staff recruitment and training files, fire safety records, maintenance records and accidents records. The home had health and safety policies and procedures that were regularly reviewed. The training records viewed confirmed that two recently appointed staff had attended health and safety training since appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting etc.). However action was needed to address some health and safety issues (lack of window restrictors and radiator covers) as part of a risk assessment. All accidents, injuries and incidents were well-recorded and appropriate action taken. Forest Home DS0000017820.V367900.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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 3 X X 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Forest Home DS0000017820.V367900.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. 1. Standard OP9 Regulation 13 (2) Requirement To ensure the safe receipt, administration, storage, recording and disposal of medicines: 1. Room temperature of medication storage facilities must remain within safe maximum recommended levels of 25°Centigrade. 2. Policies and procedures must be reviewed to include detailed guidance for as required medication (PRN) and disposal of medication. 3. The CD register must include the name and address on receipt and disposal of CD drugs. To ensure the health and safety of residents a risk assessment must be undertaken and where indicated: 1.Window restrictors must be provided. 2. Radiators must be covered. To minimise the risk of infection: 1.Staff hand washing facilities (liquid soap, paper towels and foot operated pedal bins) must be provided in all areas where DS0000017820.V367900.R01.S.doc Timescale for action 31/08/08 2. OP25 13(4) 31/10/08 3. OP26 13(3) 30/09/08 Forest Home Version 5.2 Page 26 personal care is provided. 2. Alginate bags must be provided for use in laundering foul linen. 3. Policies and procedures must be reviewed to ensure staff have clear and current guidance. 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. 3. 4. 5. 6. Refer to Standard OP1 OP12 OP12 OP16 OP22 OP28 Good Practice Recommendations The statement of purpose should be reviewed to ensure that it includes accurate details of services provided. The religious needs of all residents should be assessed and arrangements made for meeting them. More outings should be offered to enhance residents’ daily lives. The complaints procedure should be reviewed to include contact details of the local authority. A review of equipment should be undertaken and additional adjustable beds provided where a moving and handling risk is identified. The manager should continue to work towards ensuring that at least 50 of care staff obtain an NVQ level 2 qualification to ensure that people at the home are supported by skilled staff. Forest Home DS0000017820.V367900.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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