Care Home: Fosse House Nursing Home

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What the care home does well What has improved since the last inspection? At the last key inspection, which was conducted in January 2008, significant shortfalls in the standard of care provided were identified. Following the last inspection additional concerns were raised with us. These concerns have been investigated in conjunction with the local social services office, who have the lead in safeguarding matters. As a result of the concerns raised the home has not been open to new admissions until the care and support provided at the home improved to acceptable levels. As a result of this inspection it is envisaged that admissions to the home will recommence in the near future. As a result of these issues and the last inspection report the home owner, also known as the provider, has employed the services of a consultant to help identify and resolve the issues raised and improve the quality of care provided at the home. This has had a significant positive impact on the care provided. Improvements have been observed in staff recruitment, safeguarding policy and procedures, quality assurance, staff training and induction, care planning and personal care delivered to people living at the home. The number and severity of wounds and pressure damage (pressure sores) has reduced. What the care home could do better: Since the last inspection and following a period of sickness the registered manager for the home has recently left employment at the home. Mr Sykes, the interim manager/consultant, intends to continue to support the home until a new manager can be recruited. At this inspection some issues were identified. These were discussed with the interim manager at the end of the inspection. The level of social and recreational opportunities at the home is currently compromised due to the lack of an activities organiser. During the inspection we were informed that a new activities organiser had recently been employed. Recruitment checks were in the process of being completed prior to the individual commencing employment. It is envisaged that the opportunity of social and recreational opportunities will therefore improve in the near future. Although the care planning process has significantly improved some additional improvements could be made. Staff need to ensure that the care plans give clear guidance and do not contain ambiguous statements. A system of staff supervision is yet to be rolled out to all staff. Staff supervision enables the staff member to raise any concerns they may have with the management team and should occur on a regular basis. During the inspection it was identified that some medical equipment which is used rarely had not been serviced nor had an electrical safety check (PAT) been completed. Mr Sykes rectified this issue during the inspection. Two additional issue was identified relating to the care of two individuals. One of the incidents related to two incidents of falls. Equipment used during the incident may compromise the health and safety of the individual. The second incident related to the administration of insulin. Both of the issues were discussed with the interim manager who agreed to investigate these concerns. CARE HOMES FOR OLDER PEOPLE Fosse House Nursing Home South Street Stratton on the Fosse Radstock Somerset BA3 4RA Lead Inspector Justine Button Unannounced Inspection 18th August 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 Fosse House Nursing Home DS0000067689.V372025.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. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fosse House Nursing Home Address South Street Stratton on the Fosse Radstock Somerset BA3 4RA 01761 233018 01761 233632 fossehouse01@btconnect.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) TC Carehome Ltd VACANT Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to 3 places for personal care. Date of last inspection 29th January 2008 Brief Description of the Service: Fosse House Nursing Home is set in the village of Stratton-on-the-Fosse approximately 5 miles from Shepton Mallett and the City of Bath respectively. Fosse House is a registered care home that provides nursing and personal care to elderly persons of either sex, not less than 60 years, who require general nursing care. The home is registered to accommodate up to thirty seven service users. Fosse House was developed from the conversion of a large character house with an additional newer accommodation extension. The accommodation is on two floors and bedrooms are spacious. The home comprises 31 single rooms and three double rooms, plus communal space. The upper floors are serviced by a passenger lift. There are communal rooms on both floors. The large rooms are both lounge / diners. All services are provided in the home and the home is surrounded by gardens. The house looks out onto open fields and has very pleasant and well kept gardens that are accessible and have seating. Registered nurses and carers staff the home 24 hours a day. The current fees charged are £625.00 - £725.00 per week. The home also has some rooms identified for a block contract with Social Services. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key unannounced inspection was carried out over one day by one inspector. The interim Manager Mr Jason Sykes was available on the day of the inspection. The inspectors would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were five service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the home’s Statement of Purpose, staffing rosters, menus, the home’s complaint’s file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The current fees range from £625 to £725, which does not include hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Residents’ rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 6 care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home was clean, tidy and free from unpleasant odours. Residents are able to bring in furniture and personal belongings to personalise their private room. Recent improvements to the overall décor of the home were seen. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards residents. One resident described staff as ‘supportive but not intrusive’. Residents are seen as individuals and the home tries hard to accommodate their individual needs and characters. One resident said that ‘nobody wants to be in a residential home but if you have to this is as good as it gets’. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. All staff have attended all necessary mandatory training. Both of these areas ensure that staff can meet the needs of people living at the home. What has improved since the last inspection? At the last key inspection, which was conducted in January 2008, significant shortfalls in the standard of care provided were identified. Following the last inspection additional concerns were raised with us. These concerns have been investigated in conjunction with the local social services office, who have the lead in safeguarding matters. As a result of the concerns raised the home has not been open to new admissions until the care and support provided at the home improved to acceptable levels. As a result of this inspection it is envisaged that admissions to the home will recommence in the near future. As a result of these issues and the last inspection report the home owner, also known as the provider, has employed the services of a consultant to help identify and resolve the issues raised and improve the quality of care provided at the home. This has had a significant positive impact on the care provided. Improvements have been observed in staff recruitment, safeguarding policy and procedures, quality assurance, staff training and induction, care planning Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 7 and personal care delivered to people living at the home. The number and severity of wounds and pressure damage (pressure sores) has reduced. 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. Fosse House Nursing Home DS0000067689.V372025.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 Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed has a statement of purpose and service user guide, which sets out the aims and objectives of the home and includes all required information. Admissions to the home are not made until a full needs assessment has been undertaken by a member of the senior management team. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home produces a statement of purpose and service user guide that is readily available to prospective residents, their families and funding authorities. These documents have recently been up dated and now reflect the services provided. They are clearly written in plain English and a copy is available to all residents when they move into the home. All the relatives spoken to said that they had received enough information about the home. Some residents spoken to said that they had looked around the home before they moved in but others had been unable to visit and their family had chosen the home. The home produces a terms and conditions of residency that includes details of the room to be occupied and what is included in the fee but should make clear who is responsible for paying the fees, i.e. the resident or a funding authority. The home has an equal opportunity policy relevant to people living there which acknowledges peoples rights to be seen as individuals and makes clear that the home will make all efforts to meet individuals needs and aspirations. The homes pre admission assessment covers all the topics recommended in the national minimum standards. The home has recently been closed to new admissions in order that improvements could be made to the services provided. The interim manager however has reviewed the pre-admission assessment. This document is now of a good standard. Preadmission assessments will now be completed for all people thinking of moving into the home. This will give the manager and prospective resident the opportunity to meet and make sure that the home can meet their assessed needs before they move. A copy of the funding authorities assessment had been obtained and kept with the care plan. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The care planning system has improved although the majority of the plans are specific and person centred although this requires some additional development. Evidence was seen of input from the resident and/or their representative in the plan of care. Staff need to ensure that people have access to fluids at all times and that all aspects of personal hygiene are met. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. Service users were treated with respect and looked well cared for. The management and administration of medication was good. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four people were case tracked during the inspection and their care plans reviewed. An additional care plan was viewed for one individual all the care was not case tracked. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and/or their representative. All contained a range of appropriate assessments and associated care plans. The majority of the care plans were clear and detailed. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Likes and dislikes were well documented in all the plans seen. One plan was viewed for an individual who had a pressure ulcer. The care plan contained ambiguous statements such as “provide nutritional supplements if required” and “offer a well balanced diet and fluids”. People who have or are at risk of pressure damage may require increased protein in the diet to aid healing. The plan therefore needs to detail the individual’s dietary requirements and the amount of fluids required on a daily basis. The care plan for the treatment of the pressure ulcer were clear with tools such as photographs and sizes being used by staff. These tools enable staff to assess the progress of the wound and ensure the appropriate dressings/ treatment is being used. The frequency that the dressing was to be changed was made clear on the care plan. The number of people with pressure damage has improved since the last key inspection. Advise and help has been obtained from the local Tissue Viability speciality over the last few months. Again this is an improvement on information received previously. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. There was a good range of pressure reliving equipment, hoists were available. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Health and social care professionals, through surveys received, and confirmed that they see their residents in private. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. Residents spoken to confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. Feedback received from residents indicated that the majority felt that they always got the care and support they needed. Comments included “this is a wonderful home” Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 13 During the inspection it was noted that a small number of the toothbrushes and toothpaste were dry. This leads us to conclude that people living at the home had not been supported by staff to clean their teeth/dentures. It was also noted that people in the communal areas had access to fluids at all times. Drinks “rounds” are conducted throughout the day and no person appeared to be dehydrated. The home’s procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in service user bedrooms, had been marked with an expiry date and the MAR chart been signed to confirm that the creams had been applied as per the Prescription. On viewing the MAR charts it was evident that insulin had been administered to one individual when their blood sugars were low. The manager agreed to review this incident to ensure that the insulin and the time that breakfast was served did not compromise the well being of the individual concerned. Fosse House Nursing Home DS0000067689.V372025.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 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Social and recreational opportunities are currently compromised. It is hoped that this will improve in the near future. Families were seen to be welcomed and to be part of the home life. The menu is varied. The food on the day of the inspection was of a good standard. EVIDENCE: The availability of social and recreational opportunities are currently reduced due to the lack of an activities organiser. The interim manager stated that a new organiser had been recruited that that employment checks were in the process of being obtained. The care staff have been completing some activities in the interim period. The care plans viewed during the inspection detailed the Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 15 preferences of service users. People living at the home or their Relatives & friends provide information relating to their loved one’s social history, previous hobbies/interests, preferences, likes and dislikes if the individual is not able to provide this information. Those staff observed on the day of the inspection appeared to have a good knowledge of the people living at the home and what they did and did not like. Those service users able to express a view informed the inspectors that their wishes were respected and that they could choose what time to get up or go to bed. Service users can choose where and how to spend their day. Any restrictions would be identified in risk assessments. Due to mobility difficulties, not all service users can move freely around the home. Throughout the day the inspector observed regular staff presence in each of the lounges. As previously mentioned, staff interacted with service users in a kind and respectful manner. People were observed in lounge reading newspapers and chatting. On the day of the inspection a local priest was visiting. The home welcomes visitors at any reasonable time in accordance with the wishes/preferences of the service user. Visitors spoken to during the inspection were extremely complimentary about the care and support afforded to people living at the home. All meals are prepared and cooked on the premises. Copies of a two-week menu were made available to the inspector. The menu appeared wholesome and varied. The main meal is served at lunchtime with a lighter cooked meal at tea time. This was evident at the time of the inspection. The inspectors were informed that milky drinks and sandwiches were offered in the evening. Special diets are catered for. The inspector observed soft diets being served to those with an assessed need. These were seen to be attractively presented. Sweets were available for those requiring a diabetic diet. Staff were observed assisting service users in a manner which was relaxed, unhurried and respectful. Service users able to express a view were positive regarding the meals available and stated that there was always plenty to eat. Drinks were served throughout the day. A range of cakes or biscuits was available. A range of snacks was available for those with swallowing difficulties or those at risk of loosing weight. A choice of meal is available at all times. Staff ask people the day before what they would like to eat on the following day. Some people living at the home had forgotten what they had ordered. Some people may have difficulty in expressing a preference. One individual stated that he did not like the choice of Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 16 food that he had ordered. Staff were very quick to offer an alternative. The tables were set with linen tablecloths, napkins and appropriate condiments. A range of cold drinks was available through the meal. Menus are on display in each of the lounges. Independence could be more actively promoted by, for example, allowing them to serve their own vegetables and gravy although it should be noted that portion sizes were varied according to people’s appetite. Fosse House Nursing Home DS0000067689.V372025.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the home’s policies and procedures. Staff have received recent training in the prevention and recognition of abuse. EVIDENCE: Feedback from people living at the home when asked do you know who to speak to if you are not happy? All people stated that they would speak to a staff member or the manager if they had any concerns. Comments from relatives included “A wonderful home no complaints”. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. All the complaints are dealt with in line with the homes policy and procedure. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 18 The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. These policies have recently been reviewed and up dated. The home now has copies of the local abuse polies and procedures. Abuse training is included in the new staff induction programme. The training matrix was viewed as part of the inspection process and this showed that staff had recived abuse training. Staff spoken to during the inspction all now have a increased knowledge of the action to be taken should issues be identifed. The interim management at the home have been involved in reviweing and investigating the recent safeguarding issues that have been raised with home. The management have been proactive in resolving, investigating and informing the relevant authorities the outcome of these concerns. Since the last inspection the manager and the staff team have been proactive in welcoming complaints and suggestions about the service, using these positively and learning from them. Staff recruitment files were veiwed during the inspection. These contained all necessary checks. Fosse House Nursing Home DS0000067689.V372025.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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well maintained and meets the needs of the people who live there. Service users live in a comfortable & clean environment and have access to range specialised equipment. The bathroom facilities are good with a range of both baths and showers offering choice to people who live at the home. The home takes appropriate steps to reduce the risk of the spread of infection. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 20 EVIDENCE: All communal areas and the majority bedrooms were sampled at this inspection or recent random inspections. The home is on the whole well maintained. The majority of people living at the home are accommodated in single bedrooms, which are fitted with wash hand basin and some have toilets. Bedrooms are situated on the first floor and are accessed by a passenger lift and stairs. There are a number of communal sitting areas throughout the home giving a choice to residents. All bedrooms seen were individual and personalised. Residents spoken to were happy with their rooms Since the last inspection the service has been updated to include the availability of “wet/ shower” rooms. These have been completed to a high standard. This has increased the Specialist equipment is available at the home to include profiling nursing beds, mobile hoists, and pressure relieving equipment and bathing facilities. Infection control measures were in place to include hand-washing facilities for staff. Hand washing facilities are now available in the laundry area. Closed laundry bins have also been purchased Staff spoken to were aware of the actions to take to prevent any infection spreading. Staff have received training in infection control. Domestic staff spoken to during the inspection felt that the budget was adequate to keep the home clean and tidy. New equipment was purchased on request. Fosse House Nursing Home DS0000067689.V372025.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels appear appropriate to the needs of people currently at the home but these should be kept under review. The home promotes NVQ training for staff and ensures that all staff received training appropriate to their role. The home follows robust procedures for staff recruitment. EVIDENCE: Staff rota’s were viewed as part of the inspection. These demonstrates that currently adequate numbers of staff are available to meet the needs of the people living at the home. The home however has reduced occupancy due to not taking any new admissions over the last few months. The management need to ensure that as the level of dependency at the home increase that they keep the staffing levels under review and increase these if necessary. This will ensure that the hard work at improving the care and support afforded to people living at the home is not compromised. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 22 As part of the ongoing review and improvements at the home staff training has been reviewed and up dated training provided to staff. In addition the induction process for new staff has been reviewed and up dated. Staff spoken with during the inspection confirmed that they had been provided with the training needed to care for people at the home including NVQ. Staff indicated that they felt confident in their skills and they stated that they were never asked to undertake a task that they didn’t feel trained to carry out. Staff confirmed that, apart from mandatory training, they had received ‘very good’ training. The home’s procedures for staff recruitment were examined. Records relating to two staff recently employed were viewed and there was evidence that the home was following robust recruitment procedures which also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). This is an improvement on previous inspections. Fosse House Nursing Home DS0000067689.V372025.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, 32, 33, 36, 37, 38. The quality in this outcome group is good. The home is well managed in an open management style. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard, although one issue was identifed. A system of staff supervision is in the process of being developed. Health and safety is well managed. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 24 EVIDENCE: The interim manager, Mr Sykes, has been employed at the home for just two and a half months. During this time significant improvements have been made due to a stable management structure. The management style of the home is appreciated by staff and service users. All people were very complementary about his open management style. Staff described Mr Sykes as firm but fair. Mr Sykes and the staff should be congratulated on the hard work they have completed to bring what was a failing service to one in which a good standard of care is being provided. The home does not have a manager currently registered with us. Recruitment process are in the process of being completed. Mr Sykes has confirmed that he will continue to support the home until a new manager has been employed. Mr Sykes has recently undertaken a quality assurance assessment of the home; surveys have been made to assess service user satisfaction. Regular staff and service user meeting are now held. Minutes of these were seen. All records seen were stored appropriately and safely. Accident forms are completed and these are audited on a monthly basis. These were reviewed during the inspection. It was observed that one individual living at the home had had two falls from the bed. At the time bed rails were in place and it was evident that the individual had climbed over the rails to get out of the bed. In these cases it would be usual for staff to review if the use of the bed rails was appropriate (These could increase the risk of injury to the individual). This had not occurred and it could not be evidenced that staff had considered alternative strategies to keep this individual safe. These falls had occurred prior to the interim manager being employed. Mr Sykes however stated that he would review this following the inspection to ensure that the health and safety of the individual was not compromised. Staff supervision has been commenced although this has not been offered to all staff. Mr Sykes stated that this is in the process of being developed. Servicing and maintenance records were sampled these were found to be in good order. The boiler has been serviced and repairs made. The use of free standing heaters is now not required thus reducing the risk of injury from trailing wires. The sluice area has been fitted with a lock COSHH (Control of Substances Hazardous to Health) advisory sheets are held at the home. Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 3 Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 OP27 OP9 OP38 OP12 Good Practice Recommendations It is recommended that the service user plans are reviewed to ensure that they are specific and give clear guidance on the care needs of the individual Staffing levels need to be reviewed in line with the dependency needs of the people living at the home. It is recommended that the issue identified with regard to the administration of insulin to one individual is reviewed and any remedial action required is taken It is recommended that the issue with regard to the fall out bed involving bed rails is reviewed to ensure that the health and safety of the individual is not compromised. It is recommended that the provision of social and recreational opportunities be developed as soon as possible Fosse House Nursing Home DS0000067689.V372025.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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