Care Home: Forest View Care Home

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What the care home does well Residents are actively involved in the running of the home through quality assurance systems and residents` meetings. The service has a good activities programme, to ensure they can meet all the needs of residents and offers a good selection of meals. There is a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The service has robust recruitment procedures ensuring the safety of residents. The service promptly contacts health professionals where required to ensure the health care needs of residents are met. What has improved since the last inspection? At the last key inspection 3 requirements were made in the following areas; medication practices and reducing health and safety risks posed to residents in relation to the environment. At this inspection all of these requirements had been complied with. What the care home could do better: 7 requirements were made at this inspection in the following areas: the service to complete comprehensive pre-admission assessments, to ensure residents and all involved parties sign the contracts of terms and conditions; further follow up checks for residents to be completed following accidents at the home; to record the wishes of residents in the event of their death; medication practices; and the decoration of the environment at the home. Failure to act on requirements that relate to the care provided for the people living in the home may lead to the Commission taking enforcement action against the registered person, in order to secure compliance. The registered provider, the manager and the staff team may wish to refer to the Commission`s Key Lines of Regulatory Assessment (KLORA), to consider how they may additionally further enhance the overall quality of care in the home. CARE HOMES FOR OLDER PEOPLE Forest View Care Home 45 Upper Walthamstow Road Walthamstow London E17 3QG Lead Inspector Harbinder Ghir Unannounced Inspection 09:10 9 January 2008 th 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 View Care Home DS0000007221.V356465.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 View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest View Care Home Address 45 Upper Walthamstow Road Walthamstow London E17 3QG 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 8520 2361 020 8521 6663 fviewcarehome@aol.com Mr Alan Cork Mrs C N Heath Ms Janet Eaton Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include 1 named service user with a Learning Disability (LD). Date of last inspection 31st January 2007 Brief Description of the Service: Forest View is a privately run care home for older people, which provides accommodation and personal care for to up to twenty-four people of either sex. The house is a converted family house, which provides individual care in one or two double rooms or single rooms. Both double rooms and six single rooms are en-suite. The home is on three floors and there is lift access to all floors. There is a large garden, which is well used, in fine weather. The home is situated in a residential area of Upper Walthamstow and is within walking distance of a main line station. There is also a local bus service which links to the nearest underground station. As informed by the registered manager at the time of the inspection the range of fees charged by the service range between £525 and £600 per week. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 9th January between 9.10am and 4.00pm. The registered manager and one of the registered providers of the home were available throughout the time to aid the inspection process. During the inspection the inspector was able to talk to residents residing at the home and staff on duty. A second day was spent contacting relatives and professionals by telephone to obtain further feedback on the service. The London Borough of Hackney who is one of the placing authorities for the service was also contacted, inviting their comments on the service they are commissioning, which have been included in the report. The London Borough of Waltham Forest who are the host authority for the service was also contacted, inviting feedback, but no comments were received. As part of the inspection the inspector toured the home and examined documents in relation to the management of the home. A completed Annual Quality Assurance Assessment was received by the Commission for Social Care Inspection prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 3 requirements were made in the following areas; medication practices and reducing health and safety risks posed to residents in relation to the environment. At this inspection all of these requirements had been complied with. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 6 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 View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 7 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 View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 8 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): 2, 3, 4, 5, 6 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are completed by the service, but must be completed more comprehensively to ensure the needs of prospective residents are adequately recorded. All residents are issued with a written contract of statement of terms and conditions, but not all contracts had been signed by the involved parties to ensure they are in agreement with the services provided by the home. Trial visits are offered to all prospective residents and families and representatives can also visit the home, to ensure they have information on the services and facilities provided by the service. The service does not provide intermediate care Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 9 EVIDENCE: Four pre-admission assessments were closely examined for newly admitted residents. Pre-admission assessments covered the mental, physical and healthcare needs of residents. The service had obtained care management assessments and care plans from social and healthcare professionals prior to the resident moving into the home. Local authority assessments viewed on file had been obtained from the London Borough of Hackney and Waltham Forest. Records evidenced that admissions to the home only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of prospective residents. This was further evidenced by comments made by the placements officer from the London Borough of Hackney who was spoken to as part of the inspection. She informed, “Janet (manager) is very good, she does the assessments and keeps us informed of any developments. The assessments are always completed prior to admission, and she is very good at not accepting people, whose needs they cannot meet.” On examining the pre-admission assessments it was identified that some of the content of information on the assessments recorded was very brief, which was not always personalised to the individual. The assessments viewed contained answers such as the home will manage in reference to meeting residents’ personal care needs and did not further elaborate in detail on the needs identified. For one resident whose care management assessments highlighted their history of mental health, this information was not included in their pre-admission assessment. It is Requirement 1 that comprehensive preadmission assessments are completed for all residents, to ensure adequate information is obtained on the needs of residents. On viewing the care information of four residents. Contracts had been obtained by the funding authorities, which had been signed by all the involved parties. Each resident had a contract of residency issued by the home, including information on explaining residents’ rights and responsibilities in the tenancy agreement. However, not all contracts had been signed by the resident or their representative. Contracts must be signed by the resident or their representative and the home, to ensure all parties are in agreement to the services to be provided. This will be stated as Requirement 2. All prospective residents and their relatives and family are given the opportunity to visit the home prior to being admitted. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 10 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, 11 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. Care plans are detailed and ensure the needs of residents can be met effectively. Practice in relation to the recording of medication must be more robust, in order to demonstrate safe administration. Residents’ wishes at the time of their death were not always identified, to ensure that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 11 Four care plans were closely examined. Care plans were person centred and agreed with the individual. All care plans viewed were signed by the resident or their representative. Plans were written in plain language and were easy to understand and looked at all areas of the individual’s life. They covered the health, personal, mobility, medical, mental health needs of residents and made reference to residents’ likes and dislikes. One care plan stated, “B likes sweet chocolate and likes to go out shopping, she loves all activities musical.” Each resident also had a document completed called the “resident profile” which covered the past personal history of the individual including information on their childhood, adolescence, young adulthood and later years. This was a very valuable piece of information as it provided key information to staff on meeting residents’ personal care needs and identifying with their past life events. The profiles were also completed with family where possible. One relative had provided a very detailed account of their loved one’s life history which was utilised by the service when devising the care plan. Care plans also included reference to equality and diversity and addressed any needs identified in a person centred way. The home has residents who have Afro-Caribbean, Jewish and Spanish cultural heritage. On viewing a resident’s care plan who was from an Afro-Caribbean background, his dietary needs had been identified in his care plan and met by the home providing culturally appropriate food to him. Another resident whose first language was Spanish, the home had employed a Spanish speaking carer who was also the resident’s key worker. The home is commended for meeting the diverse needs of residents. Care plans viewed on providing care for individuals with dementia, provided good information on meeting the specialist care needs of people living with dementia. During the inspection, the inspector spent time at the home observing how the care staff looked after residents. Staff were observed to be interacting positively with residents, talking to residents, maintaining eye contact, talking slowly and in a manner, which was appropriate to the communication needs of residents. However, it was disappointing and concerning to observe one senior member of staff at lunchtime who was supporting a resident to eat, speak very inappropriately to the resident. On supporting to feed the resident she stated, “Swallow what you have got in your mouth and stop being so silly, open wide.” The member of staff was becoming very frustrated with the resident as the resident was struggling to eat their lunchtime meal. The comment was made in front of two other residents and one resident had to inform the member of staff that the resident she was feeding looked like she was not going to take any more food. It was only after this that the member of staff decided to stop supporting the resident to eat, without asking the individual whether they had finished. This was later discussed with the registered manager and provider of the home. The member of staff was spoken to by the registered manager who later apologised to the resident. The staff member has since been suspended pending further investigation into the incident. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 12 The documentation/ health records relating to pressure care areas; management of diabetes and falls were examined. The records for these were found to be detailed and were adequately maintained. There was evidence that care plans were being reviewed at least monthly. Risk assessments are routinely undertaken for all residents around nutrition, manual handling, falls and pressure care areas and are reviewed on a regular basis. Monthly weight checks were undertaken for all residents and appropriate action being taken where necessary. Records indicated other health professionals such as the district nurse, optical, dental and chiropody services saw residents. The district nurse was spoken to as part of the inspection. She spoke very highly of the home and stated “My relation with the home is really good and with Janet (manager). She is excellent, I have most of my dealings with her, she is very dedicated. I haven’t got any concerns about the home. Janet always contacts me if there are any problems and carers always bring things to my attention if Janet is not around. There are currently no pressure sores at the home.” The accident and incident book was reviewed. Accidents were recorded in full and regulation 37 notification of incident forms were completed and sent to the Commission for Social Care Inspection promptly where appropriate. However, follow up sheets were not completed for residents to ensure there were no further health associated risks posed to them. A requirement in relation to the above findings will be stated as Requirement 3. Out of the four care plans examined; two care plans did not include information on residents’ wishes in the event of their death. To ensure a resident’s death is handled with dignity and propriety, and their spiritual needs and rites identified, their wishes must be recorded on their care plan. This will be stated as Requirement 4. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined. The following issues were discussed with the manager of the home. -Medication Administration Records had not been completed correctly. For a resident whose records identified that they were to be administered medications only at night, on viewing their MAR chart, entries had also been signed for the morning for two of their medications. On completing an audit check of the medication the right amount had been administered, identifying that the chart had been incorrectly completed. For another medication, an entry had been signed for the 10/01/08 the day following the inspection. An audit of the medication was undertaken, and the right amount had been administered. - Medication Administration Records included the incorrect code Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 13 where medication had been refused. The code F, which represented ‘other’ had been used where a resident had refused the medication. The code R should have been used. -Medication Administration Records also included hand written entries, which had not been signed by the member of staff making them. It is Requirement 5 that medication practices are reviewed to ensure the safety of residents. All the residents and relatives spoken to, spoke very positively regarding the care they received at the home. Comments from a resident spoken to included “It is alright to live here, the staff are nice and friendly. I like living here.” Another resident spoken to informed, “The carers are good to me, they are very good, they look after me, they are wonderful. I am quite satisfied with the home and my room. I have a comfortable bed, I am content with what I have got here.” A relative spoken to whilst visiting the home when asked about her thoughts about the service informed “I like the people here, they are kind and nice, residents seem very happy. I am made to feel welcome and they always offer me a cup of tea. The home always keeps me informed if there are any problems, they are very kind.” Forest View Care Home DS0000007221.V356465.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 using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a varied programme of activities available and residents are given the opportunity to take part in a variety of activities, which meet their recreational needs. There is a wide choice of meals in the home, to ensure they meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: Staff take responsibility in organising activities throughout the home. Each resident’s preferences for social activities were also highlighted in their care plan. One resident liked to go out for walks, which he was supported to do. There was a notice board in the dining room displaying the activities organised Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 15 for the day which were undertaken by staff. Residents were seen playing ball during the morning, each throwing a ball into the net, which they all really seemed to be enjoying. There was a good atmosphere whilst residents played the game. During the afternoon residents participated in puzzles and were seen chatting and relaxing with staff. Photos of residents on weekend breaks, participating in exercises classes, Halloween celebrations, going out to pub lunches at a local pub, going for walks to the local forest and shopping trips were seen. Residents also had the opportunity to participate in reminiscence therapy sessions with their key worker on a regular basis. Each resident also had a photo album of their past history, developed with the help of their family and relatives which was also used in these therapy sessions. The service has also arranged for residents to participate in coffee mornings at another local home. The registered manager informed that the plan is to rotate these mornings at each home, so individuals have the opportunity to socialise with residents from other homes. The menu was seen which included a variety of fresh fruits and vegetables and a choice of two meals at lunchtime and snacks throughout the day. Records were seen of residents’ choices of meals for each day that they had chosen when consulted by the cook, who informed that he speaks to each resident during the morning to discuss the menu with them. On speaking to the cook, he was able to demonstrate his knowledge of those residents requiring special diets, for example diabetic and vegetarian diets. Meal times were flexible and residents could have their meals in their room. On the inspector arriving at the home, residents were seen to be having breakfast at different times and some residents were just getting ready to have their breakfast. One resident decided to have her meals in her room, which she stated, “was her own choice”, when speaking to the inspector. The inspector joined residents at lunchtime. Lunch was chicken casserole or vegetable burger, potatoes, mixed vegetables or fish pie. The choice for desert was baked apples with custard or ice cream. Portion sizes were appropriate, well presented and colourful and residents were seen to be eating their chosen choice. Residents were asked what they thought of the meal and comments included “Very nice”, “Lovely”. Some residents who had difficulty with lifting food from the plate were also provided with bowls with raised sides, to enable them to eat independently. Condiments were also placed at each table and staff were seen asking residents if they wanted more drinks. There was a relaxed atmosphere at lunchtime and residents seemed to be enjoying their meal. Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 16 Forest View Care Home DS0000007221.V356465.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 using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be assured their views are listened to and acted on. All staff have received up to date training in safeguarding adults, which ensures the protection of residents. EVIDENCE: The complaints procedure is clear and easy to follow and was displayed around the home. Timescales within which a complaint would be investigated were stated on the complaints procedure but did not clearly state that the Commission for Social Care can be contacted at any time or stage of a complaint being made. Evidence was also not seen of verbal complaints or concerns recorded by the service. All complaints about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to. This will be stated as Requirement 6. A complaints logbook is kept by the home, which was viewed. There were two recent written formal complaints logged. Residents’ concerns were recorded, which the service investigated satisfactorily. A relative spoken to as part of the inspection informed that when his mother has made a complaint it has Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 18 always been investigated by the registered manager. He stated “The manager has been very thorough in checking the complaints my mother has made and has investigated all the concerns that were raised.” The Commission for Social Care Inspection has not received any complaints about the service. All staff have attended (Protection of Vulnerable Adults) POVA training and adult protection is comprehensively covered in the induction programme. The service has comprehensive safeguarding adult procedures and protocols in place. The service has obtained safeguarding adult protection procedures devised by The London Borough of Waltham Forest. Upon entry to the home, the inspector had been invited to sign the visitors’ book, to ensure the safety of residents. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25, 26 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable home which provides a homely and pleasant living environment enhancing residents’ comfort, but further decoration and environmental safety checks would minimise risks presented to residents. EVIDENCE: The home provides a homely environment to meet the needs of residents. There are two lounges, which includes a quiet lounge and a dining room. The home has twenty-four rooms two of which are shared double rooms. Residents’ rooms were seen during the inspection, which were comfortable with adequate furnishings and was also personalised by residents with personal family photos Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 20 and furniture. All rooms were lockable and can be overridden by staff in an emergency. The home is registered to provide services to individuals with a diagnosis of dementia. It was positive to observe that there was signage throughout the home, which was appropriate to the needs of residents living with dementia. Toilets, bathrooms and bedrooms had appropriate signage, which were in colour and large print. However, during a tour of the home it was identified that the general environment of the home looks tired and worn out, particularly in the lounge and dining areas. The registered manager and provider informed that a re-decoration programme is in place, this would greatly benefit residents, in particular those with dementia. The home is registered to accommodate people with dementia. Therefore, the general environment throughout the home should to reflect good practice guidelines on dementia within care homes. It was also observed that bedroom doors were propped open by wheelchair equipment and clothing. This is a health and safety risk, as well as a fire risk. Magnetic door closures must be used on all bedroom doors to reduce any risks posed to people using the service. There was also a pair of scissors left out on a window shelf and a resident’s dermalogical cream was stored in a communal bathroom. The service must provide a safe and comfortable environment and to reduce the risks and spread of infection to residents. A requirement in relation to these findings will be stated as Requirement 7. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 21 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 using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. However the service should consider providing further training to staff in promoting individuals’ rights and respecting their dignity, to ensure residents’ needs are met the way they prefer. There is a good skill mix of staff to meet the needs of residents. EVIDENCE: Three staff files were closely examined, which were all in good order. References and Criminals Records Bureau checks had been obtained for all three members of staff. Staff had been on induction programmes and all received ongoing training. Training received included training in protection of vulnerable adults, dementia care, handling, storage and the administration of medication, moving and handling, food hygiene, and fire awareness. Staff have also received training through the Redbridge Collaborative training programme Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 22 including training in safeguarding adults and mental capacity. The service also records all records of staff training on the Skills for Care’s national minimum database. As discussed under the standards of Health and Personal care. A senior member of staff at lunchtime who was supporting a resident to eat was observed to speak very inappropriately to a resident. It is therefore recommended that the service provides further training to staffing in promoting individuals rights and respecting their dignity, to ensure residents’ needs are met the way they prefer. This will be stated as Recommendation 4. The service has a permanent staff team and does not use agency staff, which ensures a consistent service being provided to residents. Staff qualifications evidenced that the service has a ratio above 50 of NVQ qualified staff. The staff rota was examined; there are four members of staff on duty in the morning, two to three members of staff on duty in the afternoons and two waking night staff. Staff, relatives and residents spoken to felt that there was always enough care staff on duty. One member of staff stated, “ We have enough staff on, residents always get the attention they need. We get to take the resident out to the local shopping centre, we have trips to the theatre and we go out to the local forest.” The inspector also observed adequate numbers of staff on duty to meet the needs of people who use the service. Comments received from residents and relatives spoken to as part of the inspection regarding the staff team have been very positive. One relative spoken to stated, “So far the care has been very good for my mother. The food is good at the home and the attitude of staff.” A resident spoken to informed “I get up early at my own choice but go to bed anytime. The food is good, we get a choice and we can have something thats not on the menu as long as you let the cook know.” Thank you cards and compliments sent in by people who use the service were also seen. One compliment stated “I am quite happy that I am able to discuss with Janet (manager) or D (senior member of staff) any concerns or worries regarding my mother’s care. For a relative it is so important to feel that she or he can talk at anytime with the home’s staff.” Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 23 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 using the service good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. Systems for service user consultation have been implemented, to ensure residents’ views underpin all self-monitoring, reviews and developments by the home. Residents can be confident that the staff team who care for them benefit from regular supervision. Residents’ financial interests are safeguarded by the homes systems. The welfare of staff and residents is promoted by the home’s policies and procedures. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager has the required qualifications and experience to competently run the home. Staff spoken to during the inspection spoke very positively about the manager of the home. One member of staff stated “The manager is supportive, she is reasonable and always listens to us. I have been very pleased with all the training provided and I receive regular supervision.” Another member of staff spoken to informed “The management do listen to us, if we have any problems we always go to them and we can talk to them.” All professionals spoken to throughout the inspection have also made very positive comments about the management of the home which have been included in this report. Evidence at this inspection has highlighted that the manager has a clear understanding of the key principles and focus of the service, and works continuously to improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues. There is also a focus on person centred thinking, which was also evidenced in the delivery of care plans. The service has good quality assurance systems in place. Quality assurance surveys are completed with residents, family and stakeholders every month and surveys are devised each month on a particular topic such as social life within the home. This allows the surveys to be kept simple and easy to understand for residents. Results are communicated to residents through their residents’ meetings or to individuals on a one to one basis where appropriate. It was identified that results need to be communicated to family, relatives, representatives and stakeholders to ensure they are aware of how the service is planning to improve the service and to action any dissatisfactions that have been expressed, to ensure the home is run in the best interests of people who use the service. A recommendation to these findings will be stated as Recommendation 1. Staff supervision records evidenced that staff were supervised at least six times a year. However, on viewing the records not all supervision notes were recorded in sufficient detail to reflect any concerns staff may have or any practice issues that needed to be addressed. It is Recommendation 2 that supervision records are taken in sufficient details to reflect that staff are competent to meet the needs of people who use the service. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 25 The service does not manage residents’ finances; these are managed by families, representatives or the residents themselves if appropriate. The service works to clear health and safety policy guidelines. Risk assessments were viewed for fire, COSHH and manual handling which are reviewed every month. The service completes a fire drill every three months. Certificates inspected were all up to date and included the landlord gas and safety certificate, the periodic inspection report for an electrical installation, the testing of all portable electrical equipment and a certificate issued by the London Borough of Waltham Forest rating the service by four stars for its standards of hygiene at the home. The registered provider has completed monthly Regulation 26 quality monitoring visits and reports, which the Commission for Social Care Inspection has received copies of. However, the reports are very brief and do not provide enough detail of the findings of the visit or the views of service users during the visit. It is Recommendation 3 that the report format is reviewed to ensure the reports reflect the above information. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 26 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 x 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 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 3 x 3 Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement Timescale for action 30/04/08 2 OP2 Schedule 3, 5 3 OP7 OP8 12 17 13 4 OP11 12 The registered persons must ensure that comprehensive preadmission assessments are completed for all residents, to ensure adequate information is recorded on the needs of residents. The registered persons must 30/04/08 ensure that contracts of terms and conditions are signed by the resident or their family or representative and the home to ensure all parties are in agreement to the services to be provided. The registered persons must 31/03/08 demonstrate that following an accident in the home, residents are checked after their accident and follow up sheets are completed to ensure there were no further health associated risks posed to them. The registered persons must 31/03/08 ensure residents’ wishes in the event of their death must be recorded in their care plan. To ensure their death is handled with dignity and propriety, and DS0000007221.V356465.R01.S.doc Version 5.2 Forest View Care Home Page 28 5 OP9 6 OP16 7 OP26 OP19 their spiritual needs and rites are identified and can be met by the home. 13 The registered persons must 29/02/08 ensure Medication Administration Records are recorded correctly to ensure the safety and protection of people using the service. 22 (3) (4) The registered persons must 31/03/08 ensure that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to; and the complaints procedure is amended to include that the Commission for Social Care Inspection can be contacted at any time or stage of a complaint being made. 13 (4) ( c) The registered persons must 30/04/08 ensure unnecessary risks to the health and safety of service users are identified and so far as possible eliminated and magnetic door closures are used on bedroom doors. Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33 Good Practice Recommendations It is recommended that results of quality assurances surveys are communicated to family, relatives, representatives and stakeholders to ensure they are aware of how the service is planning to improve the service and to action any dissatisfactions that have been expressed, to ensure the home is run in the best interests of people who use the service. It is recommended that supervision records are taken in sufficient details to reflect that staff are competent to meet the needs of people who use the service. It is recommended that Regulation 26 visit reports provide enough detail on the findings of the visit and the views of service users during the visit. It recommended that the service provides further training to staffing in promoting individuals rights and respecting their dignity. 2 3 4 OP36 YA39 OP27 Forest View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 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 View Care Home DS0000007221.V356465.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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