Care Home: Furze Hill House

What the care home does well The service has good pre-admission procedures that ensure people are able to make an informed decision to move into the home. People receive good health and personal care, that is well recorded. People said they received care in private and staff treated them with respect. The service provides a range of activities that people can join in with if they wish. People can also choose from a range of options at mealtimes. Because the service had only recently opened, all areas were of a good standard of decoration. Facilities within the home are excellent. People are cared for by staff who receive good standards of training. Sufficient numbers of staff are employed to ensure all people`s needs can be met in a timely way. What has improved since the last inspection? This is the first inspection at this home. What the care home could do better: The following comments are made in line with recognised best practice. No requirements have been made at this inspection. Staff need to record more information about how each person likes to spend their day in the daily record. This will help staff to provide more individualised care. The service needs to ensure that their quality assurance process is fully implemented. This will demonstrate they are seeking the views of residents and others who use the service and are acting on the views expressed. Two signatures needed to be obtained for all transactions in respect of residents personal finances. This will help to ensure people are protected from financial abuse. The manager needs to develop a format that will enable analysis of any accidents occurring in the home. This will aid timely identification and reduction of risks. CARE HOMES FOR OLDER PEOPLE Furze Hill House 73 Happisburgh Road North Walsham Norfolk NR28 9HD Lead Inspector Mrs Geraldine Allen Unannounced Inspection 09:10 7th April 2008 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 DS0000070765.V375759.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. DS0000070765.V375759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Furze Hill House Address 73 Happisburgh Road North Walsham Norfolk NR28 9HD 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) 01692 502701 Salvation Army Major Alexander Bishop Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40). of places DS0000070765.V375759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: service: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE 1. The registered person may provide the following categories of 2. The maximum number of service users who can be accommodated is 40 Date of last inspection New Service Brief Description of the Service: Furze Hill is a care home, owned and managed by the Salvation Army. The service was opened in October 2007. Furze Hill is located on the outskirts of North Walsham, 15 miles from Norwich, and well served by road, rail and bus links. The service provides single, ensuite accommodation for up to 40 residents, some of whom have dementia. There is ample communal space on both the first and ground floor, that is accessible to all residents. Facilities include the village square, which has a telephone booth, a shop kiosk, cafe area, hairdressing salon and Chapel. Shaft lifts provide easy access to the first-floor. DS0000070765.V375759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that the people who use the service experience, good quality outcomes. This inspection was unannounced and took place during the day of the 7th of April 2008. Information was obtained from various sources to help us make a judgment about the quality of service provided. Before the inspection took place, the manager provided us with a copy of the homes annual quality assurance assessment. This told us about how the home is managed, run and maintained. We also received completed surveys, 8 residents and 7 relatives, telling us about their experiences of the service. These views and comments have been included within this report. On the day of inspection we looked at various records, spoke with the manager, residents, visitors and staff, toured the premises, and also had lunch with residents in the the dining-room. What the service does well: What has improved since the last inspection? What they could do better: DS0000070765.V375759.R01.S.doc Version 5.2 Page 6 The following comments are made in line with recognised best practice. No requirements have been made at this inspection. Staff need to record more information about how each person likes to spend their day in the daily record. This will help staff to provide more individualised care. The service needs to ensure that their quality assurance process is fully implemented. This will demonstrate they are seeking the views of residents and others who use the service and are acting on the views expressed. Two signatures needed to be obtained for all transactions in respect of residents personal finances. This will help to ensure people are protected from financial abuse. The manager needs to develop a format that will enable analysis of any accidents occurring in the home. This will aid timely identification and reduction of risks. 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. DS0000070765.V375759.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000070765.V375759.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has good preadmission procedures in place, that ensure people are able to make a positive choice to move to the home. This home does not provide intermediate care. EVIDENCE: Nine residents were spoken with during the course of the inspection, and all described the admission process. Some of the residents said they had visited the home before making a decision to move in, and all confirmed they had been visited in their own homes and their care had been discussed at that time. Residents felt they had received good information before moving into the home. A recently admitted resident said she had been given a booklet by the manager, telling her about home life, and she found this book very helpful. This home does not provide intermediate care. DS0000070765.V375759.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people have a care plan, that reflects their specific needs. People are involved in their own care planning decisions and staff have access to good information about this. People have access to all health care services and good records are kept of all interventions. People are treated with respect and receive care in private. EVIDENCE: Three care plans were looked at in detail. Each contained good information about the care required by the individual, how it should be provided, and information regarding interventions by healthcare professionals. There was evidence that residents are involved in their care planning. Generally, the standard of recording was good. In particular, the care plan summary was very informative and gave good, concise information to staff. There was evidence that all risk assessments were in place as needed. Daily records need to show more information about social and emotional elements DS0000070765.V375759.R01.S.doc Version 5.2 Page 10 of the residents daily living. Personal histories were beginning to be developed and will enhance the standard of information available once completed. There was evidence that residents have access to all health care, support. Medication arrangements were in inspected separately by a pharmacist Inspector. A separate inspection report regarding medication has been made. People said staff treated them with respect, and in a dignified way. They said that all personal care was provided in private, and behind closed doors. DS0000070765.V375759.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to maintain contact with relatives and the wider community. People can make choices around their daily living, and this is respected by staff. People are encouraged to be independent. The service offers a good choice of food at all mealtimes and peoples dietary needs are known and complied with. EVIDENCE: A poster detailing all of the activities taking place within the home was seen displayed in the the entrance hall. It included activities such as short mat bowls, music quiz, board games, outings, basketball, music and movement, cinema and non-denominational worship. There was also a poster about the next residents meeting taking place on 17/04/08. The hairdressing salon was in use during the afternoon of inspection. Some residents said they wished there was more activity. They referred to the weekly outing in the minibus and to regular film shows. The residents referred to the next residents meeting and said they intended to talk about activities then. DS0000070765.V375759.R01.S.doc Version 5.2 Page 12 One resident said she was waiting for broadband to be installed so that she could get online as she has her own computer in her room. Several residents said the liked to sit in the village square, and another resident said she used the library a great deal and enjoyed having access to so many books. Residents said they could receive visitors whenever they wished. Visitors were seen in the village square, sitting with their relatives. One resident was seen getting herself a drink in the village square and others were seen playing short mat bowls. There were several people sitting around the village square, reading, chatting and having their hair done during the afternoon. Lunch was eaten with five residents in the dining room. The dining room was very noisy and one resident had difficulty hearing the conversation, although this improved once the extractor fan in the kitchen was turned off. Each resident had a meal based on their dietary needs and choice. Therefore, meals provided were varied and included a vegetable bake, ham or goulash. DS0000070765.V375759.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place, but this needs to be clearly displayed so that it is accessible to all residents and visitors to the home. Residents are protected from abuse by good recruitment practices and staff training. EVIDENCE: The manager stated that no complaints had been received since the home had opened. The complaints book was seen, and no complaints were contained within it. The manager was advised to display the complaints procedure more prominently in the entrance lobby, so that it could be seen by residents and all visitors to the home. Residents spoken to said they knew who to speak to if they had concerns and were confident these would be dealt with properly. The home has protection of vulnerable adults and whistleblowing policies in place and these are well known to staff. All staff have this training as part of their induction process. All staff have a criminal records bureau disclosure completed before they start work at the home. Evidence was seen that residents have advocates working on their behalf, where appropriate. DS0000070765.V375759.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a safe and well maintained environment. There is good access to all communal areas and private space is highly personalised. There was plenty of natural light and heating was of a good level. The home was clean and tidy, with no unpleasant odours detected. EVIDENCE: A tour of the premises was undertaken. The home was very warm, and all areas were clean and tidy. All the rooms are single, with ensuite shower facilities. The door to each residents room is a traditional front door, with a letterbox and spy hole. Each bedroom was colour coordinated and the ensuite rooms were large and enabled specialist equipment to be used. Each bedroom benefited from having large picture windows. DS0000070765.V375759.R01.S.doc Version 5.2 Page 15 All communal areas were well furnished and fully accessible to all residents. Communal areas included a large lounge, large dining room, a village square, library, Chapel, and various small seating areas. Residents talked about their rooms and said they could personalise their rooms with furniture pictures etc. Several said they enjoyed the Jacuzzi bath, and also the shower. There were some issues at lunchtime in the dining-room, because the extractor fan in the kitchen was so loud it was making conversation difficult. The situation improved when the extractor fan was switched off. All laundry is done on site and there was plenty of laundry equipment installed to cope with the volume. Good infection control processes were in place. All areas of the home were clean and tidy and there were no unpleasant odours. DS0000070765.V375759.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers, and with adequate skills to ensure the needs of residents are met. The recruitment procedures used by the service are robust. Good training opportunities are in place. EVIDENCE: Three staff files were looked at and showed that good recruitment procedures were in place. Full checks had been completed on staff before they started working at the home, including criminal records bureau checks and a minimum of 2 written references. The recruitment process clearly demonstrated a commitment to equality and diversity issues. The manager stated that recent training had included first aid, health and safety, medication administration, National Vocational Qualifications (NVQ), food hygiene, and food safety. He also said that training for infection control and quality assurance had been arranged. The home uses the skills for care training home induction care training notes and workbook. Five members of staff were spoken with in private and at length. One person stated that she had already achieved NVQ at level 3, and hoped to go on to do NVQ at level 4. All staff spoken with confirmed they had received induction DS0000070765.V375759.R01.S.doc Version 5.2 Page 17 training, but not all were receiving regular supervision. A senior carer said he will be responsible for doing staff supervision and was due to have training to do this very shortly. Residents made very positive comments about the staff, describing them as lovely very nice warm. One person said the service appeared to be shortstaffed, and the home uses some agency staff from time to time. They said they dont have to wait very long for their call bell to be answered however. Interaction between residents and staff was observed throughout the day, and at all times staff were seen speaking very respectfully to residents. They were friendly, helpful and calm and did not rush the residents in any way. There was plenty of laughter, conversation and a relaxed atmosphere within the service. The staff Rota for the week of inspection was provided, and this showed that on the day of inspection there were sufficient staff on duty to meet the needs of residents. These included a senior carer, but excluded the manager. DS0000070765.V375759.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is run by a manager who is well qualified and competent. Quality assurance processes are in place, but not fully implemented. Residents financial interests are safeguarded by good practice. Staff supervision processes are in place, but not fully implemented. The health, safety and welfare of residents and people using the service is safeguarded. EVIDENCE: The manager arrived at the home during the course of the inspection. Until that point, the administrator and other members of staff provided information when requested. DS0000070765.V375759.R01.S.doc Version 5.2 Page 19 There was evidence that the manager was well qualified and competent to fulfil his role. Residents and staff spoke positively about the manager and the support provided by him. The manager stated that although the service does have a quality assurance process, it had not yet been implemented. He described how the views and opinions of residents and relatives are sought. The manager said there will be an annual satisfaction survey sent out to all residents and their relatives. He will also do a monthly questionnaire on a specified subject for residents only to seek their views. He described how he had already responded to some comments made and gave the changes to menus as an example. The service has a quality team made up of residents and staff. There is also an advisory group, which leads into the quality team and the advisory group is made up of representatives from the local surgery, clergy, and relatives. The manager said that part of his role is to do a monthly quality assurance check. So far he has done three monthly surveys covering subjects such as dignity and choice. Progress with quality assurance will be assessed at the next inspection. The personal allowance, for one resident was checked. The money held was correct against the records. All elements of the records demonstrated good practice. The administrator said that monies are checked frequently, but this is not shown on the record. Two signatures need to be obtained for all transactions. The service also looks after some residents valuables, and these are stored in the safe. The register of items held was seen, and ways to tighten the process were discussed. Staff supervision was discussed with the manager and he stated that due to a lack or principle care workers, he was getting behind with the process. He said that over the next six months all staff will have had at least three supervision sessions. Accident records were looked at and cross referred to accidents recorded in residents files. The service needs to develop a monitoring form for all accident analysis. The manager said it was the responsibility of head office to investigate any accident patterns. It was suggested that the manager should also develop a format so that he can respond more quickly than head office would be able to do. The manager said he would develop a format to do this. Fire systems and records were looked at. Fire equipment and fire detection systems remain under warranty. The maintenance worker said he checks all the fire exit routes weekly, and does a monthly equipment check. All call points are checked on weekly basis. DS0000070765.V375759.R01.S.doc Version 5.2 Page 20 No notifications of incidents had been received from the service and the manager was reminded that these need to be sent through to CSCI in a timely way. DS0000070765.V375759.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 N/A 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 3 3 3 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 3 DS0000070765.V375759.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 Good Practice Recommendations Staff need to record more information about how each person likes to spend their day in the daily record. This will help staff to provide more individualised care. The service needs to ensure that their quality assurance process is fully implemented. This will demonstrate they are seeking the views of residents and others who use the service and are acting on the views expressed. Two signatures needed to be obtained for all transactions in respect of residents personal finances. This will help to ensure people are protected from financial abuse. The manager needs to develop a format that will enable analysis of any accidents occurring in the home. This will aid timely identification and reduction of risks. OP33 3 4 OP35 OP38 DS0000070765.V375759.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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