Care Home: Foxgrove Residential Home

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What the care home does well Foxgrove is nicely decorated throughout offering a good standard of accommodation. All areas of the home are comfortable, clean and tidy. Plants, flowers and bowls of fruit are placed in communal areas, these additional touches helped to create a `homely` environment. Additionally there are books and magazines available in the lounge for people to read. People`s rooms are nicely decorated and personalised with their own possessions. To promote diversity within the home, two members of staff have signed up to the Department of Health (DOH) Dignity Challenge Programme. The DOH challenge is "to put dignity at the heart of care services". Evidence was seen throughout the inspection that people using this service are treated as individuals and are being offered a personalised service. The catering arrangements continue to provide people with nutritious and balanced meals. Residents have been consulted about the choice of menu to include favourite foods and to ensure that they are offered a well balanced diet. People spoke highly of the food, comments included, "we always have a choice of two meals, never had anything I do not like" and "the food is very good". What has improved since the last inspection? Eight requirements were made at the previous inspection. Three of these related to arrangements for the recording and safe administration of medicines. Four requirements were made to protect the health, safety and welfare of people living in the home. The remaining requirement was for the home to establish a record of residents` final wishes at the time of serious illness, death and dying. Information gathered at this inspection confirmed the home has complied or partially complied with all of the requirements. Auditing procedures and recording of medication have improved. Staff are now recording the number of PRN (as required) tablets, for example 1 or 2 paracetomol on the reverse of the Medication Administration Record (MAR) charts and using the codes to reflect if residents refuse their medication. Risk assessments for people assessed as competent to self-medicate are being reviewed monthly, as part of their dependency assessments. A tour of the environment confirmed that all corridors and fire exits are free from obstruction to allow for safe evacuation in the event of a fire. To minimise storage of equipment the home have purchased a collapsible hoist. Due to the position of the heated towel rail in the downstairs bathroom, which is situated behind the door, it is not possible to cover. A risk assessment has been completed and action has been taken too minimise the risk of residents burning themselves. The fridge temperature in the kitchen has been fixed, regular temperature checks are being recorded to ensure that food is being stored within the temperature recommended by the food safety standards. What the care home could do better: Residents funded by the local authority should be provided with a contract, which sets out the terms and conditions of residence between the individual and Healthcare Homes. Care plans must be kept up to date to ensure residents` health and well being is being accurately monitored. There are still sections of the new care plans, which need to be completed. These include resident property sheets and the resident`s end of life needs. Although the recording of medication has improved, there continues to be gaps in signing for the administration of medication on the MAR charts. Further training, supervision and monitoring of staff is required to ensure the safe administration and recording of medication. A portable and lockable medication trolley would provide a safer system for transporting and administering people`s medication.Where restraint has been used for individuals for their own protection, agreed strategies must be recorded in the individuals care plan for staff guidance on how to manage future situations. Additionally staff must receive training to protect themselves and support individuals at times where their behaviour is verbally or physically aggressive towards the staff and /or other people living in the home. The recruitment procedures are generally well managed, however one staff file had only one satisfactory reference. The required standard is two references, one of which must be the person`s last employer. People living in the home and staff remain concerned about the current staffing levels. Staff said they are finding it increasingly difficult to meet peoples` needs and keep the required paperwork up to date and are working additional hours on days off to manage this aspect of their work. CARE HOMES FOR OLDER PEOPLE Foxgrove Residential Home High Road East Felixstowe Suffolk IP11 9PU Lead Inspector Deborah Kerr Unannounced Inspection 24th October 2007 09:00 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 Foxgrove Residential Home DS0000024392.V353632.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. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxgrove Residential Home Address High Road East Felixstowe Suffolk IP11 9PU 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) 01394 274037 01394 274037 manager@foxgrove.healthcarehomesgroup.co.u k Pri-Med Group Ltd. Mrs Jennifer Coulson Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: Foxgrove is a large Victorian house that has been extended and provides accommodation for up to twenty-four older people. It is situated in a residential area of Felixstowe, not far from some shops and other local amenities. On the day of inspection there were twenty-one people living in the home. There are sixteen single rooms and four double rooms. The accommodation is over two floors, linked by a passenger lift. There is a large lounge facing the gardens with level access to the outside and a separate dining room on the ground floor. All the rooms have at least a toilet and wash basin en-suite with some having a shower or bath facility. Healthcare Homes Group purchased the home from Pri-med Group Ltd in April 2006. The new company continue to be registered and trade under Pri-Med Group Ltd. The statement of purpose has been updated to reflect the new ownership. Healthcare Homes have produced a new colour photographic brochure to support the service user guide providing detailed information about moving into the home, the services provided and access to local services. People moving into the home are provided with a contract, which specifies their agreed fees and how much they are expected to pay on a weekly basis. Fees are calculated depending on the needs of the resident; they range from £400 £600 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries and daily newspapers. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven and three quarter hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. During a tour of the home, time was spent talking with six people living in the home and four staff. The manager was available and fully contributed to the inspection process. What the service does well: Foxgrove is nicely decorated throughout offering a good standard of accommodation. All areas of the home are comfortable, clean and tidy. Plants, flowers and bowls of fruit are placed in communal areas, these additional touches helped to create a ‘homely’ environment. Additionally there are books and magazines available in the lounge for people to read. People’s rooms are nicely decorated and personalised with their own possessions. To promote diversity within the home, two members of staff have signed up to the Department of Health (DOH) Dignity Challenge Programme. The DOH challenge is “to put dignity at the heart of care services”. Evidence was seen throughout the inspection that people using this service are treated as individuals and are being offered a personalised service. The catering arrangements continue to provide people with nutritious and balanced meals. Residents have been consulted about the choice of menu to include favourite foods and to ensure that they are offered a well balanced diet. People spoke highly of the food, comments included, “we always have a choice of two meals, never had anything I do not like” and “the food is very good”. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents funded by the local authority should be provided with a contract, which sets out the terms and conditions of residence between the individual and Healthcare Homes. Care plans must be kept up to date to ensure residents’ health and well being is being accurately monitored. There are still sections of the new care plans, which need to be completed. These include resident property sheets and the resident’s end of life needs. Although the recording of medication has improved, there continues to be gaps in signing for the administration of medication on the MAR charts. Further training, supervision and monitoring of staff is required to ensure the safe administration and recording of medication. A portable and lockable medication trolley would provide a safer system for transporting and administering people’s medication. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 7 Where restraint has been used for individuals for their own protection, agreed strategies must be recorded in the individuals care plan for staff guidance on how to manage future situations. Additionally staff must receive training to protect themselves and support individuals at times where their behaviour is verbally or physically aggressive towards the staff and /or other people living in the home. The recruitment procedures are generally well managed, however one staff file had only one satisfactory reference. The required standard is two references, one of which must be the person’s last employer. People living in the home and staff remain concerned about the current staffing levels. Staff said they are finding it increasingly difficult to meet peoples’ needs and keep the required paperwork up to date and are working additional hours on days off to manage this aspect of their work. 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. Foxgrove Residential Home DS0000024392.V353632.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 Foxgrove Residential Home DS0000024392.V353632.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, 6, People who use the service experience good quality outcomes in this area. People who may use this service are provided with information they need to make an informed choice about where they live. They will have their needs assessed, which will ensure the home are able to meet their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that people considering moving into Foxgrove are provided with information about the home. Information includes a ‘choice of home folder’, which provides testimonies from people already in residence, and their relatives describing real life experiences of what it is like living at the home. There are plans to introduce a ‘resident greeter’. This will be a designated member of staff to help the individual settle in to their new environment. To support individuals considering moving into residential care who have sight and /or hearing impairments, the home are planning to develop the statement of purpose and service user guide into alternative formats, for example audio tapes. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 10 The AQAA identifies that prior to admission people are invited for a trial visit so that they are able to make an informed choice about where they live. Once they have made a decision that the home is right for them each individual will have their needs assessed by the manager or a senior member of staff to ensure the home are able to meet their specific needs. Where available supporting information is obtained from other health professionals, which help provide a clear picture of the individuals current health and well-being. The personal files examined reflected that private paying customers are issued with a contract. These clearly state the amount and arrangements for paying their monthly fees and the terms and conditions of residence. However, the files of people funded by Social Services, had a copy of the Individual Placement Contract (IPC) between the home and social services, but had no information or copy of the terms and conditions of residence between themselves and the home. Individually and collectively staff have the skills and experience to meet the needs of the people living in the home. New staff are required to complete induction training, which covers the specific needs of the people they are expected to support. Recent training has consisted of end of life care, person centred care, effective pain assessment, dementia awareness and administration of medication. The home does not provide intermediate care. Foxgrove Residential Home DS0000024392.V353632.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, 11, People who use the service experience good quality outcomes in this area. People using this service can be assured that their dignity is respected and the health and personal care they receive is based on their individual needs and preferences, however there needs to be further work to ensure their safety regarding the recording and administration of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states that the home has excellent planning documentation to support the health and social needs of the residents. Examination of three people’s care plans confirmed that a new care plan format has been introduced. The documentation is well organised and provides a comprehensive overview of the individuals health, personal and social care needs. They also identify the level of support required by staff, including decisions about who delivers their personal care and the support they need to be as self-managing as possible. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 12 Relevant health charts and assessments are in place, relating to moving and handling, self-administration of medication, pressure care, tissue viability and nutrition. Generally these are being reviewed, monitored and updated to reflect the individual’s current and changing needs and where intervention is required. However, some gaps were identified, for example, one of the care plans had a record of the individuals weight on arrival at the home. They had only been weighed twice since moving into the home. During the six months interval between being weighed it was recorded that the individual had lost a stone in weight. There had been no intervention taken to ascertain the reason for the significant weight loss. Some sections of the care plan have not yet been completed, including the resident property sheets and the spiritual and end of life needs of the residents. However, the AQAA states that the home has a bereavement pack, which supports families through this difficult time. Staff have been given a hand out at a recent staff meeting on ‘Effective Pain Assessment’, providing information on the importance of assessment and the individual, when to administer pain relief medication and to help make a decision to seek advise or assistance from the GP. However, a record of people’s wishes should still be recorded in their care plan to ensure that staff respect their wishes at the time of death and dying. This should include an established plan of care as the individuals health deteriorates, which constantly monitors pain, distress and other symptoms. The daily recording notes are well documented and reflect the care and general state of well being of the individual. Regular visits were documented showing that people are supported to access their General Practitioner (GP) and other local health services relevant to them. The AQAA states an area the home would like to improve is to be able to provide alternative therapies to improve residents well being. Information provided in the AQAA states that the home has a robust policy for the safe storage and administration of medication. It also identifies that they have made significant improvement to the procedure for administering medication. A medication best practice guide to promote professional development of staff has been produced and staff have received additional training. Additionally, medication is discussed at staff meetings and during individual supervisions. Staff spoken with and training records confirmed that staff responsible for administering medication have received up to date medication training. Following the previous inspection three requirements were made regarding concerns around the safe administration of medication. These related to recording the number of tablets administered when a prescription allows a range of doses, improved recording and regular reviews of people assessed as able to self-administer medicines. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 13 Examination of the Medication Administration Record (MAR) charts identified staff are recording information on the reverse of the chart to reflect the number of tablets administered. They are using the appropriate codes to reflect if the individual had refused their medication. However, four missed signatures were identified with no explanation to reflect if medication had been administered or refused. A senior member of staff was observed administering the lunchtime medication. At the front of each person’s blister pack, is a resident’s profile, which includes their name, a photograph for identification purposes, their GP and date of birth. Medication is mostly pre packed by the pharmacy into blister packs. These are locked in a medication cupboard near the manager’s office, however to transport the medication around the home the senior took the medication around in a carry basket. The provision of a lockable medication trolley to transport medication safely around the home was discussed with the manager, whom agreed it would provide a safer system. The controlled drugs register confirmed that the home currently have four people prescribed controlled drugs. The controlled drugs are locked separately in a metal cupboard within the medication cupboard. An audit of the control drugs against the register and people’s MAR charts was found to be accurate. Information provided in the AQAA and verified at the inspection confirmed that the home has a robust equality and diversity policy. To promote diversity within the home, two members of staff have signed up to the Department of Health (DOH) Dignity Challenge Programme. The DOH challenge is “to put dignity at the heart of care services”. People spoken with, and observation throughout the inspection confirmed that staff support residents dignity, by supporting them to maintain their independence and to make choices and have control over their daily lives. The interactions between residents and staff were observed to be friendly and appropriate. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People who use the service experience good quality outcomes in this area. People who use this service are involved in meaningful daytime activities of their own choice and receive a good standard of fresh and appealing food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home have links with the local community through their activities programme and fund raising events. A notice board in the hallway had a range of forthcoming activities, which included, quizzes, a Halloween night, services at a local church and the date of the most recent resident meeting. Minutes of the meeting confirmed that residents’ had been consulted about their choice of activities. Recent events have included a day trip to the Felixstowe Hut and a summer barbeque. Residents commented on the lovely food provided at the barbeque and discussed arranging future social activities. Regular activities include visits by the PAT (therapy) dog’s, the community library, art group, and an armchair exercise group. The home has recently purchased a new mini bus to enable residents to go on outings to areas of interest. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 15 People spoken with felt that they are involved in meaningful daytime activities of choice, according to their interests and capability. The AQAA states that the home has improved the recreational activities following feedback from residents and relatives. They have listened to residents about their choice of activities, allowing a balance between risk, aspirations and supporting individuals to make real choices and uphold their right to make decisions. For example, a resident has their own workshop within the grounds, which enables them to continue with their hobby of carpentry. People living in the home confirmed that they are given the freedom and support, where required, to make decisions about how they spend their time, keeping to their own preferred routines and having day-to-day control over their lives. They described being able to come and go as they pleased, comments included, “I am able to get out and about, I go for a walk every day after my morning coffee” and “my friend lives here, they still have their own car and they drive me to the shops”. One person described spending their day reading and writing letters to old friends, another enjoyed playing cards and scrabble, or spending time in their room listening to music or watching television. Other people commented, “I have lived here for nine years and have never regretted moving into Foxgrove” and “I get well looked after, and I get all the help and support I need”. However, several residents commented that the home used to provide a good social life, they felt this aspect of the home has declined due to people moving into the home who need more physical care and support and whom choose to stay in their rooms. People confirmed that visitors are welcome at any time and entries in the visitor’s book confirmed that friends, relatives and family visit on a regular basis. Discussion with the cook confirmed meals are all ‘home-cooked’ using mainly fresh ingredients. The food store seen confirmed that the home has a good range of quality food. The AQAA states that the home offers a balanced diet and seeks the opinion of residents regarding their choice of food. As a result they have improved the menu to include resident’s favourites as well as providing nutritious balanced meals. Nutrition was discussed at a recent staff meeting to ensure the home is providing residents with adequate carbohydrates, proteins, fats, cereals and five portions of fruit and vegetables per day. The cook was aware of the dietary needs of the individuals, where people require a soft food diet their food is puréed. The cook confirmed they puréed the meat and vegetables separately, so that they could taste the individual flavours as well as identify the vegetable by colour and texture. The lunchtime meal was observed. The food served looked appetising and was nicely presented. Tables were nicely laid with flowers and napkins. Serving dishes were provided at each table for residents to help themselves to their choice of vegetables. The mealtime was a sociable occasion with a lot of discussion. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience good quality outcomes in this area. People can expect that their complaints will be listened to, taken seriously and acted upon, however procedures for recording and reporting incidents need to be reviewed to ensure all staff are aware of strategies to follow, which protect people from potential harm or risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents are provided with a copy of the complaints procedure and the manager has an open door approach for residents and their relatives. The manager identifies in the AQAA that they could improve resident’s access to the complaint procedure by producing it an alternative format, such as videotape. The AQAA states there has been three complaints received by the home in the last twelve months. This was verified in the homes complaints log. The home’s manager and the group administration manager had investigated these. The complaints had been responded to appropriately and the complainant satisfied with the outcome. Residents and staff spoken with during the inspection were confident that if they needed to make a complaint they would do so to the manager and that they would have their concerns listened and responded to. Information provided in the AQAA and verified at the inspection confirmed that the home has robust procedures in place for the protection of vulnerable adults. Safeguarding adults training is provided for all new and existing staff. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 17 Senior staff are to undertake a higher level safeguarding adults training to ensure compliance with the joint protocol guidelines for reporting allegations of abuse, which will also include training about the Mental capacity Act. Staff awareness about abuse has been raised through the development of the person centred approach throughout the organisation. Additionally, Foxgrove have purchased a video to raise staff awareness, called ‘what do you see nurse’. Staff spoken with confirmed they had received training to recognise abuse and are aware of the home’s policies and procedures for reporting abuse through the line management structure. However all staff, particularly those with senior positions who are left in charge of the home evenings and weekends should be aware of the procedure for reporting allegations to Suffolk County Council, Adult Safeguarding Board, Customer First Team. The AQAA identified there had been one incident of restraint used at the home. Examination of incident reports of the individual involved confirmed this. The incident had been well documented and reflected the home’s policy and procedure on the use of restraint. The home had sought intervention from the GP and the Community Psychiatric Nurse (CPN) team to help manage the individual’s behaviour, however there was no agreed strategy or risk assessment documented in the individuals care plan. Where restraint has been used for an individual for their own protection, agreed strategies must be recorded for staff guidance on how to manage future situations. Additionally staff must receive training to protect themselves and support individuals at times where their behaviour is verbally or physically aggressive towards the staff and / or other people living in the home. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 18 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, 24, 25, 26, People who use the service experience good quality outcomes in this area. People can expect to live in a home that is decorated and presented to a high standard, which is comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided and verified at the inspection confirmed that the home is comfortable, clean and has a homely environment, providing a relaxed approach to life. As the home has previously been found to offer accommodation to a good standard, a brief tour of the environment was made. Foxgrove continues to offer people a home that is nicely decorated throughout. Plants, flowers and bowls of fruit are placed in communal areas. Additionally there are books and magazines available in the lounge for people to read. The furnishings and lighting throughout the home is domestic in character and suitable for their purpose. The gardens are well maintained and accessible to all residents providing a nice environment for residents to walk and sit in the nicer weather. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 19 A previous recommendation was made for the carpet on the stairs and the landing to be replaced or repaired to a good standard. The AQAA stated that the manager has obtained quotes to replace the stair carpet. However, they are finding it difficult to find a similar carpet to replace the affected area without the cost of replacing the whole carpet on the stairs and landing. Accommodation is on two floors with access via a passenger lift. Communal areas consist of a large lounge facing the gardens with level access to the outside and a separate dining room on the ground floor. The home has sixteen single and four double bedrooms, which have en-suite washing and toilet facilities. Six of the bedrooms also have an en-suite shower or bath. Additionally there are adequate numbers of communal assisted bathrooms, showers and toilet facilities to meet people’s needs. The home has received a capital grant from Suffolk Association of Independent Care Providers for improving the care environment for older persons. This money is to put towards improving the bathing facilities. People’s rooms are nicely furnished, which reflect their individual personalities and interests. People spoken with confirmed that they are able to bring small items of furniture as well as other personal items such as ornaments, pictures and photographs when moving into the home. Some residents spoke of their concerns about the changes to the building if plans to merge Maynell House, with Foxgrove, another Healthcare home next door go ahead. One individual commented, “I love my room, it is lovely, very comfortable, with lovely views, I really would not want to move”. Lockable storage space is provided for small items of value. Corridors, bathrooms and toilets are fitted with grab rails, these are positioned to provide additional support for people and to help them maintain their independence. The upstairs shower room has a heated towel rail, which has not been covered, as it would prevent the door from opening. The manager has completed a risk assessment and put measures in place to minimise the risk of injury to residents. Appropriate aids for safe moving and handling are available. To overcome storage problems and blocking exits with hoists when not in use the manager has purchased a collapsible hoist. Additional moving and handling equipment, such as slings have been provided to minimise risk of cross infection occurring through the communal use of these items. Inspection of the laundry facilities confirmed the home has good procedures in place to prevent and control the spread of infection. The laundry was clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, People who use the service experience adequate quality outcomes in this area. People using this service can expect to be supported by staff who are trained and skilled, however to ensure they are in safe hands at all times staffing levels must be reviewed and all the necessary recruitment checks must be obtained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA identified staffing numbers are appropriate to the size of the home and the needs of the residents. The home is staffed by a senior and a carer on each of the three shifts. In addition there are a team of domestic staff, catering staff and a maintenance person. The home continues to use agency to cover vacancies, maternity leave, sickness and holidays. The roster showed that the home had used agency on nine shifts over a two-week period. Staffing levels remain a concern for the number of people living in the home. This was confirmed in discussion with staff and residents who feel that people moving into the home are requiring more care and taking up more staff time, residents spoke of having to wait for assistance. Staff spoke of finding it increasingly difficult to meet people’s needs and keep the required paperwork up to date. They are working additional hours on days off to manage this aspect of their work. Staffing levels were discussed with the manager who agreed that two staff per shift is not sufficient to meet the needs of the twenty one people residing in the home. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 21 The AQAA states the home has robust recruitment procedures in place. Generally this statement is correct, however one staff file seen only had one satisfactory reference. The required standard is two references, one of which must be the person’s last employer. Examination of three staff files confirmed that all the other necessary paperwork and recruitment checks were in place, including a Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) check. Information provided in the AQAA and verified at the inspection confirmed that the home is committed to training and development of staff. Healthcare Homes have their own training manager. The training manager supports people through their induction, including the Skills for Care Induction Standards. The AQAA states that the organisation has significantly improved the training provided for supervision, food hygiene and moving and handling. Most recent training has consisted of end of life care, person centred care, effective pain assessment, dementia awareness, administration of medication and time management. Staff spoken with felt they worked as part of caring and friendly team who are dedicated to providing a good service to people living in the home. They also confirmed they receive good training, relevant to their role and which helps them to understand and meet the needs of the people using the service. All new staff are required to complete induction training. Healthcare Homes have designed their own induction pack, in line with the National Training Organisation (NTO), Skills for Care Induction. People spoken with were complimentary about the staff and were confident that they met their needs. Comments included “the manager and staff have made this place feel like home” and “the staff are first class”, however some residents felt that staff do not have the time to spend time with them on an individual basis. Figures taken form the AQAA reflect the home employs 13 permanent care staff and 2 bank staff. 2 permanent staff hold NVQ at level 2 or 3, with 4 staff working towards completion of NVQ, level 2. These figures reflect 40 of staff have or are working towards a recognised qualification, which does not meet the National Minimum Standard (NMS) of 50 . Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 22 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, 35, 36, 38, People who use the service experience good quality outcomes in this area. People using this service benefit from the leadership and management approach of the home, which is based on openness and respect and tested by an effective quality monitoring system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An experienced and competent manager is currently managing the home. However, the Commission for Social Care Inspection (CSCI) has been notified of the organisations plans to merge Foxgrove with Maynell house, next door, also owned by Healthcare Homes. It is planned that the two homes will combine to make one large care home, under the name of Maynell house. The current manager of Foxgrove is retiring at the end of October 2007 and it is proposed that the manager of Maynell house will apply to become the registered manager for Foxgrove, in the interim. Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 23 People living and working in the home benefit from the positive approach of the manager. The manager demonstrates a clear commitment to providing a service, which places value on residents and meeting their needs. Staff and residents spoken with described the manager as approachable and supportive. To show their appreciation, of the manager, residents had had a collection and presented them with flowers and chocolates at a residents meeting the previous day, to wish them well in their retirement. To ensure that people living in the home have a say in how the service is managed, regular residents meetings are held. The minutes of recent meetings confirmed that issues about the day-to-day running of the home are openly discussed. Residents and staff spoken with confirmed that they had been informed and consulted over the proposed changes, although they have mixed feelings about the merger. Some saw this as a positive step others are more apprehensive about the future arrangements, with regards to structural changes of the building and possible changes to conditions of employment and how these issues will affect them personally. Information provided in the AQAA and verified at the inspection confirmed that the home conducts an annual quality assurance, which helps to develop improvement strategies and evaluate the impact of the services performance. The views and opinions from the residents, relatives and external agencies are welcomed about the services provided. The most recent quality assurance analysis took place in March 2007. This was Healthcare Homes first quality audit since taking over Pri-med homes. The results of the residents and relative’s surveys were very positive and reflected that people were pleased with the service they receive. The AQAA states that the home provides value for money and that the occupancy rate has significantly improved, from 86 to 95 since 2005, indicating that the home provides a good service and that customer’s expectations are being met. The home does not manage the financial affairs of any of the people living in the home, however the manager confirmed that they do hold small amounts of monies for nine residents. Records are kept in a register, which showed that transactions were witnessed and had two signatures against them. The balance for three residents tracked during the inspection were checked and found to be accurate. The AQAA identifies that all staff are supervised and trained appropriatly. Staff personnel records seen confirmed that a formal supervision process is in place. Records confirmed that work issues and performance, training and further development needs had been discussed. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 24 showed that equipment and the water supply and temperatures are regularly checked and serviced. The building complies with enviromental health standards and the local Fire service requirements. The Fire alarm system is serviced on a regular basis. The fire logbook confirmed that regular training and drills take place. Time was spent with the cook, who demonstrated a good understanding of the needs of the people living in the home, the importance of good food hygiene and health and safety. All foods were being stored in accordance with food safety standards. Documentation was produced to show that the required temperature checks for fridges, freezers and food delivered to the home are being kept. Foxgrove does not have a designated staff room and staff tend to congregate in the kitchen. This arrangement does not meet the work place regulations to provide a separate room for the use of employees. This was identified at the pervious inspection. A recommendation was made for an alternative meeting area, however there is limited space within the home for a separate room to be identified. This should be considered if and when the two homes merge into one. The home’s certificate of registration was seen displayed and the home’s certificate for employers liability insurance was displayed and which expires in September 2008. Foxgrove Residential Home DS0000024392.V353632.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 4 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1-3) Requirement The care plans and health charts of the people using the service must be fully completed, monitored and reviewed regularly. Where concerns are identified these must be investigated and appropriate action taken. This will ensure that people’s health and well-being is being monitored. Medication Administration Records (MAR) must be completed whenever prescribed medication is administered to a person living in the home. This will ensure that people receive the correct levels of medication. This is a repeat requirement from 15/11/06 Further training, supervision and monitoring of staff is required to ensure the safe administration and recording of medication. This will ensure that people receive the correct levels of medication. DS0000024392.V353632.R01.S.doc Timescale for action 25/10/07 2. OP9 13(2) 25/10/07 3. OP9 13 (2) 25/01/08 Foxgrove Residential Home Version 5.2 Page 27 4. OP18 13 (7) (8) Where restraint has been used for an individual’s own protection, agreed strategies must be recorded in their care plan for staff guidance on how to manage future situations. This will ensure the individual is protected from potential harm, or risk of abuse. Staff must receive training to protect themselves and support individuals at times where their behaviour is verbally or physically aggressive towards the staff and /or other people living in the home. This will ensure that staff have the skills and knowledge when dealing with people with difficult and challenging behaviours. 21/12/07 5. OP18 13 (6) 25/01/08 6. OP27 18 (1) (a) A review of staffing hours must 21/12/07 be undertaken in conjunction with individual assessments of people using the service. This will ensure there is sufficient staff available to meet the needs of all people living in the home. The registered manager must 25/10/07 not employ a person at the home unless they have obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of schedule 2 of the Care Homes Regulations 2001. This will ensure people living in the home are protected from potential risk of harm, poor practice or abuse. 7. OP29 19 (1) (b) Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP1 OP2 OP9 OP11 Good Practice Recommendations The service users guide and other information about the home should be available in a format suitable for the people with a visual impairment. Residents funded by the local authority should be provided with the terms and conditions of residence between the individual and healthcare homes. A portable and lockable medication trolley would provide a safer system for transporting and administering people’s medication. A record of people’s final wishes should be discussed and recorded in their care plan to ensure staff respect their wishes at the time of death and dying. This information should include an established plan of care as the individuals health deteriorates, which constantly monitors pain, distress and other symptoms. The figures provided in the AQAA reflect Foxgrove have not reached the National Minimum Standard (NMS) of care staff to hold a National Vocational Qualification (NVQ). 50 of care staff should have NVQ, level 2 or above, or an equivalent qualification. To meet the work place (health, safety and welfare) regulations 1992 the registered provider should provide a separate meeting room for the use of employees. 5. OP28 5. OP38 Foxgrove Residential Home DS0000024392.V353632.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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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