Care Home: Fourfields

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What the care home does well People using the service and their relatives continue to express a high level of satisfaction with the service provided. One resident said `it is very homely here and we are well looked after. The staff are good and caring. I have been here for few years now`. Another said `I have no complaints about the home. It is nice and comfortable.` Care plans were detailed and reflected how individual`s identified needs were being met. The care team were committed to supporting people who used the service. Many staff have received training in dementia and those spoken to said that they feel more confident after the training in supporting the residents. A range of activities was offered including visits to local places of interests, accessing local amenities and organising trips to the seaside. The home was clean and well maintained, nicely decorated and odour free on the day of inspection. What has improved since the last inspection? A programme of redecoration has been started including renewal of floorings and furniture. Blinds have now been fitted to the windows in the corridors to prevent excessive heat and sunlight. CARE HOMES FOR OLDER PEOPLE Fourfields Rosedale Way Flamstead End Cheshunt Hertfordshire EN7 6HR Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 26th 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 Fourfields DS0000019350.V369870.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. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fourfields Address Rosedale Way Flamstead End Cheshunt Hertfordshire EN7 6HR 01992 624 343 01992 789 807 fourfields@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited 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) Ms Carol Withers Care Home 52 Category(ies) of Dementia - over 65 years of age (52), Old age, registration, with number not falling within any other category (52), of places Physical disability over 65 years of age (52) Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: Fourfields is a purpose built home comprising six linked bungalow-style units surrounding a central garden, an administration block containing offices, a central kitchen, laundry and recreational facilities. The home, which is run by Quantum Care Ltd, provides personal care and accommodation for up to 52 older people. All bedrooms are for single occupancy, with the exception of one that is large enough to be a double room but it is only used as such when service users have made a positive choice to share. Fourfields blends in well with the other buildings on the Rosedale estate in Cheshunt. Local amenities are nearby and a local bus service passes the door. The home offers a safe and caring environment for its service users, some of whom suffer from dementia. Current fees for the home range from £420.14p to £560.00 per week (as at 26/08/08). Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. ‘The overall quality rating for this service has been judged to be 2*, GOOD.’ This unannounced key inspection was carried out on the 26th August 2008 and took one day. It included talking to people using the service, their relatives and visitors, staff, examining care plans, staff files, staff training records, fire safety procedures, maintenance records, all other records and documents and a tour of the premises. Information received by the Commission since the last inspection has also been reviewed. An Expert by Experience (Ex by Ex) took part in the inspection. The Ex by Ex is a person who has experience of care services for older people. The Ex by Ex met and talked to people using the service and participated with them in the day care activities being provided on the day. Feedback received from people using the service was very positive. They said that they are happy with the staff team and the care they received. What the service does well: People using the service and their relatives continue to express a high level of satisfaction with the service provided. One resident said ‘it is very homely here and we are well looked after. The staff are good and caring. I have been here for few years now’. Another said ‘I have no complaints about the home. It is nice and comfortable.’ Care plans were detailed and reflected how individual’s identified needs were being met. The care team were committed to supporting people who used the service. Many staff have received training in dementia and those spoken to said that they feel more confident after the training in supporting the residents. A range of activities was offered including visits to local places of interests, accessing local amenities and organising trips to the seaside. The home was clean and well maintained, nicely decorated and odour free on the day of inspection. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who would like to use the service are able to make an informed choice and be sure that their needs could be met. EVIDENCE: People using the service, their relatives and visitors spoken to said that they had received information about the care home to help them to make a choice. Care plans examined showed that a pre-admission assessment of needs was carried out by senior members of staff. Information was also obtained from relatives, health professionals and social workers so the most up to date information on residents’ health and social care needs was available. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their personal and healthcare needs would be met appropriately. EVIDENCE: People using the service said that their identified needs were being met and were complimentary of the staff and the care they received. All residents looked comfortable, well dressed, groomed and some were participating in the planned activities being provided. Six care plans were examined and these provided information about the residents, their assessment of needs and how these needs were being met. Risk assessments were also carried out and each care plan included a ‘life history’, personal care needs, life and activities, health diagnosis and treatment, daily records and other information relating to each individual. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 10 These plans of care were ‘person centred’ and were reviewed regularly to reflect the changing needs of the individuals. However, nutritional assessment taken for each resident should include weight gain or loss and appropriate action taken. Staff spoken to said that they were aware of the rights of residents to make choices about their lives and the need to ensure their privacy and dignity is respected. They also commented that the home does well as the staff worked as a team and are very caring. The systems in place for ordering, storage, managing, administrating and reviewing medication meet the required guidelines to ensure residents receive the medication they are prescribed and it is kept safely. However, records of the temperature where medicines are stored were not kept and medicines returned for disposal were not signed by the pharmacist. It was also noted that hand written instructions on medicine record sheets were not signed by the person making the entries. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 11 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 – 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their identified needs would be met appropriately and that they would be enabled to live the lifestyle they chose. EVIDENCE: The Expert by Experience (Ex by Ex) reported that the atmosphere in the home was that of a ‘happy home’ where residents expressed their satisfaction with the service provision. The Ex by Ex had lunch with the residents and it was noted that the fishcakes and dumplings provided for lunch went very well. However, one resident had the fishcake covered with gravy that did not look appetising. Residents said that they were provided with choices to the main menu. It was also noted that fresh fruits, fresh fruit salads and fresh orange juices were provided at breakfast. Mealtimes were flexible to suit personal choice; breakfast is prepared in the unit kitchenettes when people are ready to eat, and residents get up when they chose. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 12 A weekly planned programme of activities was displayed in each unit and other notice boards, Staff said that residents were reminded daily of the activities plan for the day that they took residents out to local shops, trips to the seaside, garden centres and other local places of interests. There was a key worker system in place and residents spoken to said that this was a good system and that they new their key workers who support them with their daily choices and life style. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 13 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their concerns and complaints would be listened to and acted upon and that they would be safeguarded from abuse, neglect and harm. EVIDENCE: People using the service and their relatives spoken to, confirmed that they feel they are able to raise any concerns and staff would listen to what they have to say and take appropriate action. The management team receives low number of complaints and invites residents and relatives to contribute their views as part of the quality monitoring procedures they have in place. Staff confirm there is an open culture within the home and that they understand their role in reporting any concerns should they arise. The training records provide evidence that issues regarding the safeguarding of residents are regularly considered. There were two complaints and fifteen compliments received since the last inspection. Both complaints were dealt with in accordance with the home’s complaints policy. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 14 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are cared for in an environment that is homely, comfortable and safe. EVIDENCE: People using the service said that the ‘ it is homely and comfortable place to live in’ and that they are able to bring their personal belongings that were seen in individual’s room. The environment is well designed for the needs of older people who may have restricted mobility and confusion and residents are able (should they chose) to walk through from one unit to another by linking corridors. One of these communal areas has now been fitted with blinds to so that it can be used safely during the summer months. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 15 On the day of the inspection the home was clean, fresh and well maintained. The grounds are well maintained with residents having level access to an outside garden area in each unit. The unit is decorated and equipped to a high standard and has a comfortable and homely atmosphere, with a range of equipment available to assist staff when working with people with a physical disability. Residents’ bedrooms seen were personalised and individualised in their décor. A maintenance programme is in place and refurbishment is therefore on going. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 16 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- 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service do benefit from the care and support they receive from a competent and trained staff team and that they feel protected by the home’s recruitment policy and practices. EVIDENCE: People using the service and their relatives said that there is a good team of staff who are caring and helpful. Six staff files were examined. These confirmed that there are robust processes in place to ensure suitable people are employed and the required checks, including references and Criminal Records Bureau checks, are carried out prior to staff being employed. There is a staff training and development programme in place for all staff, which ensures they are up to date and feel confident in their roles. National Vocational (NVQ) training is made available to the care staff and domestic staff. Currently, there are 16 care staff who have completed their NVQ Level 2. Two care staff are currently undertaking this course and another 3 members of staff have completed their NVQ Level 3. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 17 Staff spoken to confirmed that they received regular formal supervision and felt that the overall support provided was very good. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their health, safety and welfare are protected by the systems and practices in place and the care and support they receive from an open and transparent management team. EVIDENCE: Staff spoken to said that there is an open management culture and good teamwork, which promotes the interests and well being of residents. They also said that they received formal supervision on a regular basis. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 19 There is a quality assurance system in place covering all aspects of the service provided including resident’s rights and quality of life. The auditing systems provide evidence that action is taken to address any shortfalls identified. Residents and or their relatives are able to deposit small amounts of personal money in the office for day-to-day expenditure. The records reviewed demonstrated that there was a clear process for auditing and monitoring transactions. Staff receive the required statutory health & safety training to carry out their jobs and protect residents. Records of accidents, incidents and checks on health & safety and fire equipment are recorded and regularly reviewed. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of people using the service and staff are promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. CSCI has been kept informed of all accidents and admissions to hospital. Regular checks on hot water temperatures and moving and handling equipment were recorded. However, it was noted that there was no record of the temperature for all fridges and freezers used in the main kitchen. A valid insurance certificate was displayed in the reception area and this offered cover of no less than £5 million. Equality and diversity issues are understood by the organisation and addressed for individuals through their care plans, which describe how individual needs, and preferences are to be met. Policies and procedures are adjusted in response to changing legislation and guidance. Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 X 3 X 3 X X 2 Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 21 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. Refer to Standard OP8 OP9 Good Practice Recommendations Nutritional assessment taken for each resident should include weight gain or loss and appropriate action taken. a) Hand written instructions on medicine record sheets should be signed by the person making the entries. b) Records of the temperature where medicines are stored should be kept. c) Medicines returned for disposal should be signed by the pharmacist. Records of the temperature for all fridges and freezers should be kept. 3. OP38 Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fourfields DS0000019350.V369870.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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