Care Home: Foxmead

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What the care home does well A full assessment process is in place to ensure the individual needs of service users are clearly identified prior to admission, which ensures the home can fully meet their needs. Prospective service users and/or their representatives are encouraged to visit the home before making a firm decision to move in. Where possible they are able to maintain contact with family, friends and the local community. People who use the service are offered a healthy balanced diet. The overall cleanliness of the home is of a very good standard. The service evidenced a firm commitment to staff training and development. What has improved since the last inspection? There have been improvements in the home since the last inspection in line with a statutory requirement awarded and good practice recommendations made in the last inspection report. The home`s Statement of Purpose and Service User Guide has been made available in a large print format to better suit service users and their representatives who may find reading small print difficult. Some of the flagstones on the communal patio area were seen at the last inspection to have become loose. These have been fixed and the area is now safe for service users to access with staff support. Since the last inspection the home has organised redecoration of four bedrooms and some of the corridor areas. A sash window has been repaired. New carpets have been fitted in three service user bedrooms and in the sitting room. There is a new sofa in the lounge. The manager confirms that the home has an ongoing maintenance and renewal programme to ensure that service users continue to be provided with a safe, homely and attractive place to live. The manager was recommended to follow a more robust recruitment policy to ensure service users safety and protection. On sampling the staff files during this visit it was evident that recruitment procedures have improved over the last 12 months. Staff files now evidence two written references for the staff employed. What the care home could do better: Some safe working practices require further development to address minor shortfalls and to ensure that the safety and welfare of service users is consistently promoted and protected. Service users would benefit from a greater variety of indoor and outdoor activities being offered to them and a more person centred approach to their leisure and social care needs. People living in the home and those that visit would benefit from further improvements being made to the premises and to the exterior grounds to ensure that Foxmead continues to be a safe and comfortable environment that is fit for purpose.There is the potential for the quality of the care to be compromised by some staffs poor communication skills. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foxmead Foxmead Horsham Road South Holmwood Dorking Surrey RH5 4JX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marion Weller     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home Name of care home: Address: Foxmead Horsham Road Foxmead South Holmwood Dorking Surrey RH5 4JX 01306888053 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : aisah@hotmail.com Mrs Evelyn Ramdass care home 14 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 14 14 The maximum number of service users to be accommodated is 14 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Foxmead is a Victorian property situated four miles south of the town of Dorking. The service provides accommodation and care for up to fourteen older people who have a past or present mental illness and/or dementia. There are ten single occupancy bedrooms and two shared bedrooms on the ground and first floor of the home. None of the bedrooms are en-suite, however, all have a washbasin. Communal toilet and bathing facilities are located close to all bedrooms. The first floor accommodation can be reached by the main staircase, which has a chair lift fitted. There is a break in the Care Homes for Older People Page 4 of 30 Brief description of the care home chair lift track across the landing between the ground and first floor. There is no shaft lift fitted and therefore the home is not suitable for those with very limited mobility. There are two large lounges and a dining room, which overlook the garden. The garden is large and has wheelchair access via a ramp. There is ample parking to the front of the property for visitors and a regular bus service operates to Dorking, which stops outside the home. The weekly fees range from #500 to #650. Care Homes for Older People Page 5 of 30 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: two star good 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: The last key unannounced inspection of this service was completed on the 20th May 2008. Marion Weller, Regulatory Inspector, conducted this key unannounced inspection of Foxmead on the 12th May 2009 and was in the home from 10:45 am until 5:45pm. During the site visit the inspector spoke with one member of the care staff, the Registered Manager and the owner of the home. Due to the mental health difficulties experienced by service users, direct views about their care could not be obtained. Parts of the home were toured and some records and documents were inspected. Care Homes for Older People Page 6 of 30 The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and letters received and any complaints or allegations notified to the CQC. The manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document provided relevant information that gave an indication of what was happening in the service and their plans for further development. Surveys were given to service users relatives, staff and other professionals involved with the home to find out their level of satisfaction prior to the inspection taking place. Survey respondents appeared to be very satisfied with the care provided. Survey forms included the comments: .....Foxmead offers superb individual care. .....We are very happy with the care that Foxmead provides and feel very fortunate to have found such a home. And .....The staff, as a rule, treat my relative as a member of their family A survey respondent asked to comment on how the service could improve said .....By increasing physical activity such as walking in the garden when the weather is suitable. The same respondent added when asked if they wanted to tell us anything else said.....The drive from the road to the care home is full of pot holes which may be damaging to cars if they get much worse. Other statements made by survey respondents are included throughout the text of the report. No complaints have been made to the CQC about this home since our last inspection, neither have we been involved in any safeguarding alerts in connection with Foxmead . The manager, owner and the staff gave their full cooperation throughout the site visit. What the care home does well: What has improved since the last inspection? What they could do better: Some safe working practices require further development to address minor shortfalls and to ensure that the safety and welfare of service users is consistently promoted and protected. Service users would benefit from a greater variety of indoor and outdoor activities being offered to them and a more person centred approach to their leisure and social care needs. People living in the home and those that visit would benefit from further improvements being made to the premises and to the exterior grounds to ensure that Foxmead continues to be a safe and comfortable environment that is fit for purpose. Care Homes for Older People Page 8 of 30 There is the potential for the quality of the care to be compromised by some staffs poor communication skills. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 can be confident that their needs would be assessed prior to a place at the home being offered and they would receive enough information on which to base their decision about moving in. Evidence: There have been no new admissions since the last inspection. However, evidence held by the Commission and from information obtained during the course of the inspection indicated that all prospective service users would have their needs and aspirations assessed prior to a place being offered. The home has an admission and referral policy and procedure that is followed when referrals are made to them. The document includes a statement that prospective service users and/or their relatives and representatives are encouraged to visit the home prior to admission to assess the quality, facilities and suitability of the home. Care Homes for Older People Page 11 of 30 Evidence: Since the last inspection the homes Statement of Purpose and Service User Guide has been made available in a large print format. The manager states in her AQAA ....in order to improve how we provide information to our residents, we can provide our Statement of Purpose and our Home Brochure in a format that is more reader friendly for people who find it difficult to read small print. Short term respite care can be provided if a room is available and the service can meet the persons needs. There is no specific accommodation for short term care; the service user is free to join in with daily life in the home. Foxmead does not provide intermediate care. Care Homes for Older People Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is able to demonstrate that service users receive personal care and support in the way they prefer and their physical, emotional and health needs are being met. They would benefit further from shortfalls in the homes medicine storage procedures being addressed and the manager making regular audits to ensure the home complies with good practice demands designed to protect service users from any potential for harm. Evidence: Each service user had a care plan. Two care plans were looked at in detail. Care plans were found to contain comprehensive information about service users individual needs, choices and preferences and provided necessary direction for care staff on how their health, personal and social needs were to be met. The care plans viewed had both been regularly reviewed. It was evident from records and discussion with the manager that the health care needs of residents are closely monitored and any deterioration or change is acted upon without delay. The visits and outcome of health care Care Homes for Older People Page 13 of 30 Evidence: professionals consultations were clearly recorded and records were signed and dated. Daily records for service users were being maintained. These detailed how individual needs were met by staff and gave an account of the persons well being throughout the shift. Some improvements were recommended in the last report in relation to the organisation and maintenance of service users care documentation and daily records to better evidence the homes good practice. On this inspection there was no evidence to suggest that the manager had made the improvements. Prior to this report being written however, the manager contacted the CQC and gave a verbal assurance that the work has now been completed. Not all care plans evidenced the signature of the individual receiving care. It was discussed with the manager that each care plan must be signed by the service user to show their involvement with the drawing up of the plan and their agreement to its content. If this is not achievable then the reasons why the individual is not being involved should be clearly recorded. The manager stated her firm intention to address this issue. Risk assessments for service users were in evidence and those seen provided clear guidance and direction to staff. At the last inspection it was discussed with the manager that generic risk assessments should be further developed to eliminate all avoidable hazards to the service users welfare. For example, service user have no individual fire evacuation risk assessments, even though some service users lack capacity and would need careful management and support to evacuate the building in an emergency. It was acknowledged that risk assessments are now in place for service users accessing the gardens. The arrangements for the safe receipt and disposal of medication were largely robust. The home has a policy and procedure in regard to the administration of medicines to service users and uses a monitored dosage system provided by a local pharmacy. Medicine Administration Records (MAR) were evidenced for recording the medicines given to service users. As a result of a statutory requirement issued in the last inspection report, hand written transcriptions in service users MAR are now signed by the person making the hand written entry and also by a second person to confirm accuracy. The home maintains records of medicines received and returned to the Pharmacist. Medicines are stored in a locked metal medicine cabinet. This is permenently fitted to the service users dining room wall. The manager confirmed that no service users are capable of self-administering medication and that staff designated to administer Care Homes for Older People Page 14 of 30 Evidence: medicines have all attended suitable training. One mediation shortfall was evidenced on this visit and was discussed with the manager. Topical medicines were seen on view in two service users bedrooms. It was discussed that creams and ointments can be kept in peoples rooms, but safe and secure storage must be available and the person asked if they are happy for the products to be kept there. No agreements were recorded on the individuals care plan and free access to medicines, of whatever type, could potentially place individuals that lack capacity, and other service users living in the home at risk. The manager removed the items straight away and stated her firm intention to resolve this shortfall to good practice. No survey respondents raised any concerns about service users health and care needs. One survey respondent recorded that; ....The home offers superb individual care. Another respondent said ....the care staff always take care of my relative so well. During the tour of the premises the manager was noted to knock on all bedrooms doors before entering. Service users were addressed respectfully and kindly using their preferred name and title. Issues of privacy and dignity are included as part of staff induction training. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Foxmead experience a lifestyle in the home that largely matches their expectations and preferences. They would benefit further from a greater variety of indoor and outdoor activities being offered. Service users are able to maintain contact with family and friends and they are offered a healthy balanced diet. Evidence: Care plans include information about the likes and dislikes of service users. There is a programme displayed that indicates that set activities are provided and these include word and number games, exercise with music, card games, colouring and traditional board games. When asked how the care home could improve a survey respondent said....By increasing the amount of physical activity offered to service users, such as walking in the garden when the weather is suitable. The manager stated that a dedicated activities organiser attends the home once every three weeks to offer more structured activities to the people living there. The manager records in her AQAA plans for improvement in this outcome area over the next 12 months.....to go out as much as we possibly can and provide live entertainment in house. It was clear from Care Homes for Older People Page 16 of 30 Evidence: observation and discussion that service users would benefit from such improvements to ensure a greater variety and frequency of activities offered to them. The manager said that the religion of all but one service user is Church of England, and people living in the home are supported to attend church every Sunday. This provides them with the opportunity to continue supporting their faith and to meet other people outside of the home. The manager said that members of the local church congregation visit the home on occasion and spend time chatting with service users. There are no restrictions to visitors at the home, and people living there are able to meet with their relatives in any of the homes communal areas or use their bedrooms to entertain guests if they wish. A survey respondent recorded ....Visitors are always welcome at any reasonable time, without prior notification. The home uses a three week rolling menu that offers choice and variety to service users. The manager stated that service users views are sought in relation to menu planning and the service provides for individual and specific dietary needs. Mealtimes are relaxed but largely set events. Staff were observed to be patient and helpful and allow residents the time they needed to finish their meal comfortably. The homes occupancy has fallen to five permanent service users over the last couple of years. Due to falling activity levels, staff rosters have been revised. The manager stated that they were kept under review and staff deployed in the home was always in direct relation the dependency needs of the service users in residence. Care staff undertake food preparation and cooking duties as well as the direct care of residents. Evidence of training in food hygiene was observed in staff training files sampled. The homes kitchen was viewed and was seen to be scrupulously clean and tidy. The manager said that the home had an inspection by the Environmental Health Officer in May 2008. No recommendations for improvement were made as a result of the visit. The manager stated that the two staff on duty in the home during daytime hours are deployed to be either with service users or undertaking other non caring tasks. It was observed that service users were not left unsupervised or unsupported due to their mental health needs and obvious vulnerability. The manager steps in and covers if care staff are busy elsewhere. On the day of the site visit, the homeowner stepped in and covered the managers duties to ensure the safety and welfare of the people living there during the inspection. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives can be confident that their complaints and concerns would be listened to and acted upon. There are systems in place to protect residents from abuse. Evidence: The service has strategies in place to ensure that those who live in the home and those that visit can make their views and complaints known. The homes AQAA records that they have not received any formal complaints since the last inspection. The homes complaints procedure would benefit from review to ensure it provides people with the contact details of the CQC and the local Social Services department. Social Services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. The manager has awareness that the quality of the service provided is the responsibility of the provider and concerns and complaints should be raised with the home in the first instance. Survey respondents confirmed that they knew who to complain to if they had any concerns. One survey respondent said ....I know how to complain but I have had no need, staff are always kind and helpful. The Commission has not received any complaints about the home, neither have there been any safeguarding alerts raised in the last twelve months. Records confirm that most staff have received training in safeguarding vulnerable Care Homes for Older People Page 18 of 30 Evidence: adults and update sessions are planned on a rolling programme. There is a procedure for the protection of vulnerable adults and a procedure for staff to whistle blow. Staff are made aware of both procedures during their induction. POVA First and Criminal Record Bureau checks have been obtained for all staff to further protect people living in the home. The registered manager is aware of her obligations with regard to ensuring the safety of service users and protecting them from abuse. She discussed the additional support she provides to her staff in this important outcome area and the reason for doing so. Most staff employed are recruited from abroad and their first language may not necessarily be English. The small client group are all predominantly English speaking and are especially vulnerable due to their mental health problems. The manager said she closely monitors effective communication between staff and service users to ensure people needs are consistently met and they feel safe and secure in the home. Staff receive additional training in developing effective communication skills by attending improving English language courses at local colleges. Care Homes for Older People Page 19 of 30 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 homes environment is meeting peoples individual and collective needs satisfactorily with some shortfalls evidenced where refurbishment or repair work is needed as a priority to ensure standards are maintained to service users benefit. Evidence: A tour of the premises was undertaken with the manager. Service users bedroom accommodation is provided on two floors of the property. The ground floor consists of one double bedroom, large entrance hall and stairs, a communal lounge, common room with library books, a communal dining room, laundry and kitchen. The first floor accommodates further bedrooms for single occupancy, communal bathrooms and toilets. Bedrooms viewed were appropriately furnished and kept very clean and fresh. Bedrooms that were occupied evidenced that service users are encouraged to bring some of their own personal possessions with them into the home. The manager and the registered owner of Foxmead confirmed that some windows and doors in the home are to be replaced on a rolling refurbishment programme. The window that needed repair to a broken sash cord and mentioned in the last report has now been repaired and is functional again. It was recommended to the manager that where other bedroom windows are in a state of disrepair or broken, new admissions should not be accommodated in them until the planned refurbishment of that room Care Homes for Older People Page 20 of 30 Evidence: takes place. The home has a large and attractive garden to the rear and side of the property which is well maintained. There are steps leading down to an ornamental pond. Service users, particularly in good weather, access the garden area regularly according to the manager. Some of the flagstones on the patio area were seen at the last inspection to have become loose. The homes AQAA records that these have been fixed and the area is now safe for service users to access with staff support. Training files sampled provided clear evidence that staff had attended training in relation to infection control measures and the home has a policy which staff are expected to follow. No shortfalls were evidenced in this outcome area and adequate measures are in place in the home to protect service users from harm. Some areas of the building internally and externally are aged and in need of refurbishment. The registered owner, who was present during the site visit, confirmed that a rolling programme of refurbishment and renewal is in place. Since the last inspection the home has organised redecoration of four bedrooms and some corridors. New carpets have been fitted in three of the bedrooms and also in the sitting room and there is a new sofa in the lounge. New double doors and a concrete slope have been installed to allow better disabled access to the homes communal grounds. Upon inspection the slope appeared to have a rather steep incline. It was recommended to the manager that the angle be checked by an Occupational Therapist to ensure service users are not placed at risk of falls or trips. There are large potholes evident to the surface finish of the homes entrance driveway. Temporary repairs have taken place since the last inspection but the area is still in need of a permanent fix to ensure the access driveway is fit for purpose. The manager and the owner confirmed that the necessary repairs are scheduled. One survey respondent said when asked how the home could improve.....The drive from the road to the home is full of potholes, which may be damaging to a car if they get much worse. No other survey respondents raised any issues about the homes environment and for the purposes of this report it is accepted that it is currently meeting peoples individual and collective needs satisfactorily with some shortfalls where refurbishment/ repair work is planned. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff deployed is currently meeting service users needs and staff recruitment procedures have clearly improved. There is the potential for the quality of the care provided to service users to be compromised by some staffs poor communication skills. Evidence: The manager revised the staff duty roster in January 2008 due to falling occupancy and activity levels in the home. Two care staff are deployed on each shift together with the manager during day time / weekday hours. There is one waking night staff and one carer on call to meet the needs of the five service users. The manager explained that staff live on the premises and when off duty can be called upon to help during night hours or at weekends if necessary. Care staff undertake both the cooking and the domestic duties in the home. The manager is aware that cooking and domestic duties should not be carried out to the detriment of providing personal care to service users who require it. Proportionally however Foxmead is a small service and staff on duty are being viewed more as support workers required to multi task, rather then carers required to provide only dedicated personal care. Care Homes for Older People Page 22 of 30 Evidence: The manager explained that if staff are either cooking or cleaning, one of them on duty ensures they are available to support and meet service users needs when they require it. The manager stated that staffing would be increased if the homes activity and occupancy levels increased. There was sufficient staff on duty during the day of the site visit to meet the needs of the five service users in residence. The owner attended and worked along side care staff to enable the manager to assist with the inspection process without compromising service users safety. In the last inspection report the manager was strongly recommended to follow a more robust recruitment policy to ensure that service users welfare was protected. On sampling the staff files during this visit it was evident that recruitment procedures have improved over the last 12 months. Staff files now evidence two written references for staff recruited from abroad via an employment agency. Agency documentation previously sent to the manager evidenced that references had been obtained for these staff, but they were not sent to the manager for her to make an informed decision about the individuals employment or to evidence the homes good practice in this area. This has now been resolved. The homes AQAA states that care staff are either qualified at NVQ level 2 and level 3 or they are undertaking their qualification. Staffs training certificates were seen. These covered subjects such as Induction, Dementia, Protection of Vulnerable Adults, Equality, Diversity, Nutrition, Infection Control, Food Hygiene and Medication Administration training. The manager had a list of training dates arranged for the next twelve months that included refresher training and mandatory training for new staff. Since the last inspection the manager has developed a staff training summary that provides an overview of staff training completed, booked and updates due. The recommendation made in the last inspection report to provide this ready overview to assist the homes planning will be removed from this report. The home has no plans to vary their policy of recruiting staff from overseas whose first language may not be English. The homes AQAA records that the ethnicity of service users accommodated is predominantly White / British. The manager is aware of the potential communication difficulties this can sometimes create for services users. In relation to this issue the manager stated that she ensures staff employed and accommodated at Foxmead attends improving English courses. These are designed to offer them the opportunity to improve their verbal and comprehension skills and their understanding of English cultural matters. The manager is aware that she must closely monitor this aspect to ensure that service users care and welfare is not compromised by some staffs poor communication skills. Care Homes for Older People Page 23 of 30 Care Homes for Older People Page 24 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered owner and the manager continue to respond to the need for improvements to be made to the service. Some safe working practices require further development to address minor shortfalls and to ensure that the safety and welfare of service users is consistently promoted and protected. Evidence: The registered manager has worked at Foxmead for 6 years. Records evidence that she has a Masters Degree in Social and Healthcare and successfully completed the Registered Managers Award in 2005. The manager continues to update her skills. The homes AQAA records several specialist training courses she has attended this year in relation to the Mental Capacity Act and Deprivation of Liberty Standards. She states that information gained would be used to inform her future revision of polices and procedures in the home and to raise staff awareness of new and updated legislation. Care Homes for Older People Page 25 of 30 Evidence: As mentioned throughout this report there have been some improvements both in practice and administration since the last inspection in line with statutory requirements and good practice recommendations. Supervision of staff continues to be more regular and the homes Quality Assurance systems, although simplistic, are being further developed in response to a recommendation that service users and their advocates views should be regularly sought and acted upon. The manager stated that residents and their relatives continue to handle their own finances; the home does not have any dealings in regard to this matter. Sampling of staff training records evidenced that staff receive mandatory and update training as required. In response to a recommendation made in the last report, a staff training matrix is now available to give a clear overview of staff training completed and that which is planned or required to update staffs knowledge and skill base. The homes AQAA records that health and safety records are appropriately maintained and up to date. Records sampled included fire drills. Fire extinguishers had also been serviced regularly. The home could evidence generic fire risk assessments compiled by The local Fire Service. Due to the vulnerability of service users and the geography of the building which is arranged over three floors, it was discussed that service users care plans should also include individual fire evacuation risk assessments. A fire door was seen to be wedged and the manager recognised this as bad practice. It was discussed that blue fire safety signs must be adhered to for everyones protection in the home. The door wedge was removed during the site visit. The homes AQAA was informative and gave some indication of what was happening in the home. It does however require further development to ensure it details actions taken to meet statutory requirements and good practice recommendations made in previous reports and gives a clear, detailed and comprehensive picture of service developments and improvements. The appendix to the AQAA, which should contain the homes workforce data was missing. The manager used an old AQAA template and was unaware of the regulators revised data requirements. This was however detailed in our letter to the manager requesting the AQAA. As mentioned elsewhere in this report, the manager must undertake regular audit checks to monitor compliance with procedure and good practice in relation to correct medication storage and to continue to monitor the situation regarding effective staff communication to ensure service users needs are consistently met. There was clear evidence on this site visit of management being more proactive and addressing health and safety issues before they become a problem, although there is Care Homes for Older People Page 26 of 30 Evidence: more to be done. Good outcomes for service users are demonstrated and survey respondents were satisfied with, and complimentary of, the service offered at Foxmead. The manager and owner evidence a willingness and clear potential to make the necessary service improvements. This has impacted on the overall quality rating in this report. The home now requires a period of further development in line with KLORA and sustainability. Care Homes for Older People Page 27 of 30 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 28 of 30 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 The manager must undertake regular audit checks to monitor the homes compliance with good practice guidance as written in the Handling of Medicines in Social Care by The Royal Pharmaceutical Society 2008. The shortfall in current practice regarding topical medicines must be addressed to ensure the safety and welfare of service users. 30/06/2009 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 16 It is recommended that the homes complaints procedure is reviewed to ensure content meets fully with the demands of regulation and good practice. 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