Care Home: Fosse House

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What the care home does well Fosse House provides a comfortable, homely and caring environment to the people who live there. We spoke with several residents who told us `we are very well looked after here, the staff are really nice.` Another resident said `I`m very happy, I have a wonderful group of people looking after me, they are very kind.` We spoke with one relative who said `the staff are wonderful, they are like angels. I have absolutely no concerns. They always ring me if their is a problem. I would highly recommend the place.` We also spoke with a district nurse who regularly visits the home who said `communication with the staff is very good, they have good, organised medication procedures. Pressure sore prevention and care is good, the staff always complete risk assessments and food and fluid intake charts.` The home has introduced a new care planning system, which is very person centred and provides comprehensive and current information about a person`s need. The plan also records people`s aims and personal goals, choices and preferences. Their is a wide range of activities and social events available to suit people`s needs, including for those people who may not wish to participate in group activities. The home has a wishing tree where people can place a wish on the tree and the staff group aim to make this come true. One resident`s wish came true when staff organised for her to go on a helicopter ride. Feedback about the food was also very positive. people said `the food is great, we get lots of choice.` Another person said `we always get nice, fresh food and if we don`t like what is on the menu we can ask for something else.` The home has extensive internal and external quality assurance processes and auditing systems in place. The people we spoke with said they know how to make a complaint, however none had felt the need to. What has improved since the last inspection? A resident`s committee has been formed in order to be able to gain the views of the people who live there. Some of the bedrooms have been redecorated and new carpets and bedroom furniture have been replaced. Staff have received extra training on Advanced Care Planning, Dementia Awareness, Equality and Diversity, Mental Capacity Act and Deprivation of Liberty Safeguards. What the care home could do better: We did not make any recommendations or requirements as the outcome of the inspection was excellent. Key inspection report Care homes for older people Name: Address: Fosse House Hykeham Road Lincoln Lincs LN6 8AA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Jessop     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Fosse House Hykeham Road Lincoln Lincs LN6 8AA 01522524612 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: manager.fosse@osjctlincs.co.uk www.osjct.co.uk The Orders Of St John Care Trust care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 42 The maximum number of service users to be accommodated is 42. Date of last inspection Brief description of the care home Fosse House cares for older people needing personal care in a detached property situated on the outskirts of the historic City of Lincoln. The home stands in its own grounds and gardens with car parking facilities to the front. Local facilities include shops, churches, pubs, and a recreational centre. Transport is required to access the main city. The home has two floors and there is a passenger lift to the bedrooms on the first floor. There are a variety of aids and adaptations around the building to allow residents to move around the home more independently. All of the bedrooms are single, none have en-suite facilities. The home is one of 16 operated by the Order of St John Care Trust, which is a Registered Charity. The current weekly fee range is £360.00 - £536.00. Additional costs are made for hairdressing, personal toiletries, Care Homes for Older People Page 4 of 24 Over 65 42 0 Brief description of the care home newspapers, holidays and chiropody, these are all private arrangements and costs are met by individual residents. The Order of St Johns Care Trust will be completely redeveloping this service commencing in 2010. A new care home is being developed along with extra care accommodation. Residents currently living in the home will be moved into the new care home when building work is fully completed. Further information about the development and timescales can be obtained from the manager of the service. A copy of the service users guide and statement of purpose can also be obtained from the manager. Care Homes for Older People Page 5 of 24 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: three star excellent 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 was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. The visit lasted approximately five hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting the standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of three people through their care records and assessing Care Homes for Older People Page 6 of 24 their care. We spoke to five people who use the service, one relative, a district nurse and three members of staff. The Registered Manager was present throughout the visit and the general outcomes of the visit were discussed with her. Care Homes for Older People Page 7 of 24 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 Care Homes for Older People Page 8 of 24 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 24 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 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust admission procedure which ensures peoples needs can be met. Evidence: We looked at the care plans of three people and saw that a comprehensive assessment had been completed to find out about peoples needs and preferences. One person we spoke with said I came directly from a hospital in another county and therefore couldnt visit the home before I moved in, however I was given a leaflet about the home and my relative was able to visit the home and have a look around. The home does not provide intermediate care. Care Homes for Older People Page 11 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems focus on peoples strengths and abilities. Care is provided in a sensitive way and promotes peoples independence. Evidence: The Order of St Johns Care Trust is piloting a new care planning system at this home which the staff said appears to be working well. The care plans contained detailed information on peoples needs, areas of risk, personal aims and goals and intervention and actions that needed to be taken. Each area of the care plan also includes a monthly evaluation and progress report. The care plans we saw described peoples needs in relation to personal care, mobility, nutrition, skin integrity, medication, mental state and cognition, communication, social, cultural and religious needs, pain and breathing and resting and sleeping. We saw that people had been involved in writing and agreeing their care plan and individual choices and preferences had been recorded. We spoke with one resident who had been living at the home for one week. They said we have a very good routine already and the staff give me plenty of time to do as Care Homes for Older People Page 12 of 24 Evidence: much as I can for myself. The resident also said my dignity is protected by the staff, they are very nice people. We saw that peoples health care needs are regularly reviewed and records are kept of any visits from health professionals such as GPs and district nurses. We spoke with a district nurse who visits the home regularly. They said communication with the staff is very good, they have good, well organised medication procedures. Pressure sore prevention and care is good, the staff complete the waterlow risk assessments regularly and food and fluid intake charts are properly completed. The staff are always helpful and we always know if someone has a slight redness to the skin as the staff are quick to report this to us. The medication systems had been regularly reviewed by the Lincs Pharmacy Advisory Service. No issues were identified at the last review. Medication systems appeared to be well organised and staff receive regular training on medication procedures. Care Homes for Older People Page 13 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home have access to a wide range of activities and people are appropriately stimulated to meet their individual needs. Evidence: The home has employed an activity co-ordinator who works 20 hours a week providing and organising a range of activities. The activity programme displayed in the hallway included bingo, quizzes, carpet bowls, games and crafts, PAT (pets and therapy) dog, movement to music, reminiscence, art, dominoes and coffee mornings. The staff and residents were busy preparing for their Christmas Fayre where money is raised to pay for various outings, parties and other sociable events. During the summer a 50s tea dance was arranged where residents from other homes in the group attended and were entertained by a live band and an Elvis impersonator. In the hallway is a wishing tree. Residents can place a personal wish on the tree and the staff try to arrange for this to come true. One resident asked to go on a hot air balloon ride. Although this was not possible for safety reasons, the resident had instead enjoyed a helicopter ride. Another resident had asked to visit the holiday resort that she had been to for many years with her late husband. The staff arranged this and we saw photographs of the resident re-visiting places from the past. Care Homes for Older People Page 14 of 24 Evidence: We spoke with residents to get feedback about the food. One person said the food is very nice, we have plenty of tea, coffee and fresh fruit. We also have a small glass of wine with lunch, its great. Another person said we get a good choice of food and the meals are very nice. Menus are displayed on the dinner tables and people can ask for alternative choices if they dont like the menu choices. The home has introduced flexi breakfasts, this is a buffet style breakfast so that residents can eat at a time to suit them. Care Homes for Older People Page 15 of 24 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 are protected from abuse by robust and safe procedures. Evidence: During our visit none of the people living in the home, visitors or the staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. The manager told us that no complaints have been received however a record had been kept of the several compliments made about the service. We spoke with two care staff and one housekeeper who told us that they have received training on Safeguarding Adults. A copy of the Lincolnshire County Council Adult Safeguarding procedure is stored in the home. The staff also told us that they know about the Whistle Blowing Procedure. There has not been any adult safeguarding investigations in the last 12 months. Care Homes for Older People Page 16 of 24 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 live in a clean, comfortable, safe and well maintained environment. Evidence: The home looked clean and had been well maintained throughout. The bedrooms had been personalised to suit peoples choices and taste and matching bedspreads and curtains had been provided. People are encouraged to bring items of furniture from home with them. One person said I feel very at home here, I have a loverly bedroom. Communal areas are spacious with sufficient space for those people who use wheelchairs to move around freely. The garden is also very spacious and nicely laid out with lots of seating areas and a summer house. The garden is a sensory garden which has been planted out with plants and flowers to stimulate the senses. Each bedroom has an alarm bell and the main door has a key pad, residents are given the code for this so that they can enter or leave the building as they so wish. Suitable equipment is provided which is regularly tested and serviced. Care Homes for Older People Page 17 of 24 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. There is a well trained staffing team that provide sensitive and caring support to people. Evidence: We spoke with several residents who were positive about the care they receive from the staff team. One person said the staff are great, they are very kind and caring and always help me when I need them. The staff team are made up of a manager, care team leaders, care assistants, housekeepers, an administrator, catering staff and a maintenance person. We gained feedback from two staff. On the day of the inspection a presentation was given to a member of staff who was retiring they said I have worked here 20 years, its like my second home, Im really going to miss it. Other staff that we spoke with told us that they receive regular training and feel supported by the manager. We looked at the staff recruitment and training files of two staff. The files contained a check by the Criminal Records Bureau (CRB) and two references. When new staff started work at the home they received a supported nationally recognised induction programme during which time they learnt about the policies and procedures of the home and how to provide the necessary care and support to the people living there. Care Homes for Older People Page 18 of 24 Evidence: All staff had received mandatory on-going training and the manager told us that 80 of staff have obtained a National Vocational Qualification (NVQ). Care Homes for Older People Page 19 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is highly experienced and qualified to run the home. There are robust quality assurance systems which ensure that people are safe and satisfied with the service they receive. Evidence: The registered manager has been in post for several years and has gained an NVQ level 4 & 5 in management. The staff that we spoke with said that the manager is very supportive and is very approachable. We spoke with the administrator of the home who showed us that the personal finances for people are well organised with accurate records kept of all income and expenditure. People do have access to lockable facilities should they choose to manage their own personal finances. Financial systems in the home are regularly audited both by the administrator and during external audits. The Orders of St John Care Trust has a comprehensive established quality assurance Care Homes for Older People Page 20 of 24 Evidence: procedure which consists of a comprehensive internal audit by the Quality Assurance Group. Audits include medication, financial, environmental health, fire safety, policies and procedures and risk assessment audits . Surveys and quality audits are carried out regularly. We saw that risk assessments are carried out on both the environment and on peoples individual care needs. Each risk assessment had been regularly reviewed and people were encouraged to take risks whilst measures had been put in place to protect them. Care Homes for Older People Page 21 of 24 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 22 of 24 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 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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