Care Home: Fosters

What the care home does well This service provides a good standard of care for the residents living within the home. There is a dedicated core of longstanding and consistent staff that provides continuity for residents. Management and staff work hard to maintain the home in a homely fashion. The service enjoys a positive relationship with health care professionals that benefits residents. Plans of care are sufficiently detailed to provide clear guidance for staff on how to meet residents needs. What has improved since the last inspection? Improvements have been made to the outside space, which benefits residents. Residents, their relatives and representatives where appropriate are now more actively encouraged to be involved with the formulation of their plans of care. Equipment such as a large screen TV and a Wii have been purchased for the benefit of residents. Some bathrooms, toilets and the upstairs kitchens have been refurbished. Some lounges have been re-decorated and carpeted for the benefit of residents. Five staff have gained National Vocational qualifications and provides residents with more trained staff. What the care home could do better: The service must be more vigilant in the safe storage of materials hazardous to health in order to protect the welfare of residents. The arrangements for storage of equipment must be reviewed to ensure it does not pose any danger to staff or residents. The provision for protecting residents and staff from infection must be more robust and be more consistently applied. Plans of care should contain risk management strategies more consistently to safeguard residents. Arrangements for the administration of medication must be more robust in order to protect all residents. Key inspection report Care homes for older people Name: Address: Fosters Fosters Lane Woodley Reading Berkshire RG5 4HH     The quality rating for this care home is:   one star adequate 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: Sally Newman     Date: 2 8 1 0 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 26 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 26 Information about the care home Name of care home: Address: Fosters Fosters Lane Woodley Reading Berkshire RG5 4HH 01189690630 01189695113 ann.martin@wokingham.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wokingham Borough Council The registered provider is responsible for running the service care home 36 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fosters is a residential care home that was built in the 1960s and is operated by Wokingham Council. The home provides accommodation and care for up to thirty six older people. Fosters has been organised to provide separate dining, kitchen and Care Homes for Older People Page 4 of 26 Over 65 0 36 36 0 1 7 1 0 2 0 0 8 Brief description of the care home lounge areas for 4 distinct groups, one of these areas is registered to provide care for people diagnosed with a dementia related problem. The building is situated in a residential area in Woodley. Local transport services are nearby. There are parking spaces available on site. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 inspection that was conducted over the course of three days and included a visit to the service by two inspectors of just under five and a half hours duration. The last inspection of this service was undertaken on 17th October 2008. Information provided by the service prior to the visit and a range of records were seen and were used to formulate the judgements and the outcome of this inspection. In addition, time was spent with the assistant unit manager, care staff and some ancillary staff were spoken to briefly. Four residents were spoken to in detail. A range of bedrooms and communal areas of the home were seen and observation of care practise was undertaken throughout the course of the visit. The provider has a range of polices and procedures relating to equality and diversity. From the evidence seen by the inspectors and comments received, the inspectors consider that this service would be able to meet the needs of individuals with various Care Homes for Older People Page 6 of 26 religious, racial or cultural backgrounds. No complaints have been received about this service by the Commission since the last inspection. Safeguarding meetings have been held in relation to medication errors occurring in the home and the service has co-operated fully with these procedures. This home provides a good standard of care but needs to focus on longstanding health and safety issues and the challenges of providing a service to increasingly frail people who suffer from various degrees of dementia. Requirements have been made in relation to health and safety matters and the administration of medication. Various good practise recommendations have been made in respect of reviewing important documentation and storage of equipment. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 26 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives can be confident that they will be provided with the information necessary to determine whether the service will meet their needs. Evidence: Evidence was provided from examination of documentation, from information provided by the service prior to the visit and from discussion with the Asst Unit Manager, staff and residents. Two plans of care were seen for the latest admissions. These were detailed and provided information from referring agents and in one case extensive information from a hospital. It was noted that neither of these files contained a preadmission assessment undertaken by the home. The Asst Unit Manager confirmed that this was because both residents were well known to the home as they had both been respite users prior to permanent admission. The service should consider transferring relevant information from the respite files to the working plans of care to ensure that all important details are easily accessible. Care Homes for Older People Page 11 of 26 Evidence: It was confirmed from information provided by the service prior to the visit and by the Asst Unit Manager that wherever possible all prospective residents are invited to spend time in the home before a final decision to move in is undertaken. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information is in place to enable staff to meet the health and personal care needs of residents. The arrangements for medication are not sufficiently robust to ensure the protection of residents. Residents feel they are treated with respect. Evidence: A random sample of four plans of care was seen. All contained comprehensive information about individual needs and provided staff with clear guidance on how those needs should be met. There was evidence of regular review from discussion with the Asst Unit Manager and all aspects of a persons lifestyle including there personal, health and social care needs are considered. There was evidence within plans of care that a wide range of health care professionals are called upon to meet the health care needs of individual residents. During the course of the inspection a visiting General Practitioner and a Physiotherapist were spoken to in private. Both were complimentary about the service and the GP commented that staff were well informed, followed instructions and residents were well cared for. There was evidence that mobility aids are utilised to assist service users and appropriate guidance is sought on their correct use. Care Homes for Older People Page 13 of 26 Evidence: There have been a number of medication errors within the home over recent months. This has led to a thorough review of the arrangements which was undertaken by a Pharmacist from the Primary Care Trust. A new policy has been drafted and is awaiting the results of a consultation. It was noted that a complaint was made by a relative approximately five weeks prior to the visit involving discarded medication found in a residents room. Although the record noted that an investigation would be undertaken there was no indication as to whether this was underway or concluded. In addition the inspector found medication, presumably discarded by a resident, on the floor in one of the lounges. The Asst Unit Manager undertook to follow up these matters and report to all concerned including the Commission. Throughout the course of the inspection staff were observed interacting appropriately with residents and were respectful of their right to privacy. However, despite being raised at the last inspection it was noted that incontinence pads were still on display in residents bedrooms. The Asst Unit Manager undertook to address this with staff and agreed that with many bedroom doors remaining open during the day the dignity of those residents effected, was not being fully upheld. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities is offered that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its residents. Evidence: Evidence was provided from information supplied by the service prior to the visit, from discussion with residents and staff and from feedback from the activities organiser and Asst Unit Manager. During the course of the visit a game of bingo was held in which ten residents participated. The event was enjoyed by all and stimulated discussion, interaction and laughter. Residents spoken to indicated that daily events take place including regular exercise sessions. A hairdresser visits weekly and a range of entertainment is brought into the home. Opportunities for attendance at local day centres are made available and transport did arrive to take some residents to local facilities. The home does have access to its own vehicle that is utilised for outings and appointments. Contact with family and friends is promoted and the visitors book demonstrated that Care Homes for Older People Page 15 of 26 Evidence: there is a constant flow of various visitors to the home. Residents are encouraged to participate in making decisions for themselves and they are now more actively involved with their plans of care. All residents are now nutritionally screened when they move into the home and a review is undertaken if weight changes are significant. The menus have been seen by the community dietitian and she has been recently consulted about a proposed winter menu for the home. Residents spoken to praised the food on offer and confirmed that choices are always available. The chef is experienced and the kitchen received a 5 star food safety rating in March 2009. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure, which is clear and accessible. Residents views and comments are listened to and acted upon. Residents are protected from abuse and exploitation by well-trained and competent staff who demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing polices. Evidence: There is a robust complaints policy and associated procedures that residents are encouraged to utilise. Overall the service responds well to complaints and records demonstrate the outcome of investigations. As already stated elsewhere in this report the last entry in the complaints record has yet to be concluded. It was apparent from evidence obtained on the day that residents are actively encouraged to voice their views and concerns and all those spoken to who were able to offer a view were confident that their opinions and observations are taken seriously. There was evidence from staff training records seen that all relevant staff have received up to date training in the safeguarding of vulnerable adults. There have been recent incidents where the home has consulted and referred to the safeguarding cocoordinator appropriately. This has demonstrated an openness and a clear understanding on the part of the service of the principles of safeguarding vulnerable adults. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, homely and well-maintained environment for residents. The home is mostly clean and tidy and hygienic throughout. Evidence: The home throughout was mostly clean although it was noted that one of the downstairs lounges was in need of hoovering. The decor is homely in communal areas although some bedrooms appeared sparse with linoleum type flooring. Maintenance is undertaken by a dedicated maintenance man and issues are dealt with promptly. The outside court yard space had been improved with new furniture, plant pots and the addition of water features. This space was being used by a resident and their visitor. Bathrooms and toilets to the upstairs area had been refurbished and downstairs communal space was due for refurbishment. It was noted that in those toilets seen not all contained soap or paper towels. The laundry would have benefited from cleaning to the floor. It was noted that COSHH materials were on display and a cupboard within the laundry area where further COSHH materials were stored was unlocked and easily accessible. This issue has been dealt with under the health and safety section of the report. It was noted that in information provided by the service prior to the visit there was no action plan for the control of infection available in the home. It is recommended that an action plan is drawn up in consultation with the Environmental Health Dept. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are robust and protect residents from harm. Staffing levels are appropriate to meet the needs of the residents. Residents benefit from a well trained and competent staff team. Evidence: This service benefits from a core of longstanding and consistent staff. Recent recruitment had resulted in five new care staff being made offers of employment. It is felt that the addition of these staff will greatly enhance the functioning of the home. Staff reported that the team work closely together and support each other. It was observed that there were sufficient staff on duty and this was supported by those residents who provided an opinion. Staff were highly regarded by those residents spoken to and some individuals were selected for particular praise. Records indicated that all staff received regular one to one meetings with their immediate managers and a range of staff meetings are held that involves different grades of staff. Records seen indicated that appropriate topics are discussed and attendance is good. Records for handover meetings provided evidence that information is passed between shifts appropriately and efficiently. Staff knowledge of individual needs was of a high standard and was evident in discussion with individual staff members. Care Homes for Older People Page 19 of 26 Evidence: All staff are supported and encouraged to undertake National Vocational Qualifications and information provided by the service confirmed that approximately 60 of care staff have achieved an NVQ qualification. A rolling programme of training is provided for staff and records indicated that all staff were up to date with core training. Records seen indicated that all relevant checks have been undertaken on staff and the Asst Unit Manager confirmed that all volunteers are now subject to the same recruitment checks as paid staff. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well managed home and their views and those of their relatives are actively sought and acted upon. The systems for health and safety are not sufficiently robust to ensure the protection of residents at all times. Evidence: At the time of the inspection the registered manager was on compassionate leave. The Asst Unit Manager was deputising in her absence and assisted with the inspection process. It was noted that the registered manager is due to commence a year long sabbatical commencing at the end of November and recruitment for a replacement was underway. The service carried out a quality assurance exercise earlier in the year and the results provided positive feedback about the care and service provided. It is planned that this initiative will be repeated on an annual basis. Residents monies are stored securely and individually. An improvement has been that Care Homes for Older People Page 21 of 26 Evidence: all relatives now received a monthly statement of accounts that is administered electronically. An audit of residents monies was not undertaken on this occasion. There is a dedicated maintenance man who is delegated the responsibility to undertake regular fire safety checks and there was evidence of this within records seen. The fire risk assessment requires an up to date review and a recommendation has been made in this regard. It was noted that a cupboard marked as keep locked was not. This cupboard contained electrical equipment and flammable materials were being stored within. The Asst Unit Manager arranged immediate removal of the flammable materials and the securing of the cupboard. Storage of large amounts of items were noted in cupboards throughout the home. These were not considered to be particularly well organised. A large amount of equipment and materials were also being kept in the unused lift shaft. It was noted that wheelchairs and hoists were still being stored in stair wells. In discussion with the Asst Unit Manager she confirmed that she had made a request for the Fire Service to visit the home for advice and she would also address the concerns raised about storage. In view of the potential hazard from fire a requirement will be made for the home to consult with the Fire Service and the results of this consultation and the action taken should be made available to the Commission. COSHH materials were stored in the laundry room to which residents have access. In addition, a large cupboard within the laundry which contained a range of COSHH materials was left unlocked. A container of sharps was seen in the staff cloakroom which is an area that is not secured and to which residents can easily gain access. Access to such potentially hazardous items places residents at risk. The procedures for the storage of COSHH materials and equipment that could harm residents must be reviewed as a matter of urgency. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 To ensure that the 20/11/2009 administration of medication is effective and that refusal is monitored and addressed and addressed. To ensure that residents receive the medication they require and that refusal does not place other residents at risk. 2 26 13 Following consultation with the Environmental Health Dept implement an action plan for the control of infection. To prevent the spread of infection. 20/11/2009 3 26 13 Ensure all toilets are equipped with soap and towels. To prevent the spread of infection. 20/11/2009 Care Homes for Older People Page 24 of 26 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 4 38 13 Ensure that all materials and 20/11/2009 equipment potentially hazardous to residents is appropriately stored. To safeguard the welfare of residents from harm from hazardous materials. 5 38 23 To consult with the Fire Service as to the potential for fire resulting from the storage of materials and equipment throughout the home. To safeguard residents and staff from the potential for fire. 20/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 10 19 38 Ensure the storage of continence pads does not impact negatively on the privacy and dignity of residents. Ensure all areas of the home are kept in a clean condition. Carry out a review of the appropriateness of the fire risk assessment. Care Homes for Older People Page 25 of 26 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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