Care Home: The Forbury

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What the care home does well The service has a sustained track record of improvement to meet or exceed the National Minimum Standards. We looked at the information in the AQAA and our judgement is that the home strives to provide an excellent service and that they know what further improvements they need to make. The service listens and responds to individuals` choices and decisions about daily life. People are supported and helped to be independent and can take responsibility for their personal care needs if able. Staff listen to people and take account of what is important to them. This is particularly notable in the way service users are enabled to engage in activities. Comments in surveys returned to us showed satisfaction with the way staff interact with people using the service. People say that they feel they are treated as individuals and `are at home` rather than `in a home`. What has improved since the last inspection? Staff understand the complexities of providing care for older people including those with dementia and how the condition affects each person as an individual. Staff have explored better ways of recording the care plans which have shown a significant improvement in their content. The recording of risk assessments is more robust for activities within the home and for people going out into the community. The bathing facilities are better with modern equipment for assisted use. Hairdressing days are more dignified with the provision of a separate facility. What the care home could do better: At the last inspection the manager was new to the post. She has worked with the provider, senior staff and care staff to improve the way the service is delivered. The service has demonstrated that it now has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. Where weaknesses emerge the service recognises and manages them well. CARE HOMES FOR OLDER PEOPLE Forbury The Church Street Leominster Herefordshire HR6 8NQ Lead Inspector Lorraine Briggs Key Unannounced Inspection 21st February 2008 09:30 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 Forbury The DS0000024735.V359975.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. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forbury The Address Church Street Leominster Herefordshire HR6 8NQ 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) 01568 613877 01568 612089 Mr Christopher Anthony Lutton Mrs June Bakewell Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (28), Old age, not falling within any other category (28), Physical disability over 65 years of age (28) Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2007 Brief Description of the Service: The Forbury provides a service to older people who have care needs arising simply due to their age or because they have particular needs due to physical disabilities, a dementia illness or other mental health difficulties. The building is a large Grade 1 listed Georgian house in the market town of Leominster. It is situated in a quiet street within walking distance of the town centre and the local church and park. An extensive refurbishment project has been underway for 3 years resulting in more single rooms, ensuite facilities and communal space. The kitchen has been upgraded and a salon quality hairdressing room is now completed. Fees range from £425 to £455 per week. Forbury The DS0000024735.V359975.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 *three star excellent service. This means the people who use this service experience excellent quality outcomes. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, survey results from people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? Staff understand the complexities of providing care for older people including those with dementia and how the condition affects each person as an individual. Staff have explored better ways of recording the care plans which have shown a significant improvement in their content. The recording of risk assessments is more robust for activities within the home and for people going out into the community. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 6 The bathing facilities are better with modern equipment for assisted use. Hairdressing days are more dignified with the provision of a separate facility. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forbury The DS0000024735.V359975.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 Forbury The DS0000024735.V359975.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): Key Standard 3. 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs assessed so that they can be assured that the service will try and provide the necessary care. EVIDENCE: From records seen the service considers carefully the needs assessment for each prospective service user before agreeing admission to the home. Examples of assessments are within care plans viewed. The manager ensures that a summary of any assessment undertaken through the care management arrangements is obtained and insists on receiving a copy of the care plan. Prospective service users and their family, have the opportunity to visit and spend time in the home prior to agreeing admission. A service user survey returned commented that: “ when I came to view the home, the staff were very welcoming and answered any questions that I had”. Staff are prepared to visit the prospective service user and their family to get Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 9 to know them and answer questions. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 10 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): Key Standards 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service aims to address and meet assessed need through the continued development of plans of care, so that service users are provided with person centre care. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: From discussions with the manager, the service believes in the service users’ right to be involved in the planning of care as it affects their lifestyle and quality of life. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 11 Care plans seen at the last key inspection were a work in progress with the intention of providing good information with clear direction to staff on how they are to deliver care. New care plan documentation has been introduced to enhance the understanding of providing support for a person, while not undermining their remaining abilities. Care plans looked at show the recording is written in a way that demonstrates personal preferences and wishes are taken into account, and staff can provide a verbal account of this, and service user surveys state they do. The service demonstrates that they have carried out their duties as required under the Mental Capacity Act for those service users with dementia. Key workers are appointed who build up special relationships with service users and work on a one to one basis. They are also involved in the recording of the reviews of care. This aspect of the service has improved. Records of medication reviews in the care plans indicate staff awareness of each individual’s sensitivities to drugs and how this affects their mental wellbeing. Regular checks on staff practice ensure that policies are being adhered to. Staff receive formal training before administration of medication is considered to be included in their role. Records of risk assessments for use of equipment and other interventions seen in the care plans demonstrate this aspect of care has improved. Nutritional risk assessments assist in identifying problems at an early stage and those at risk of becoming malnourished. Service users have a care plan which identifies their nutritional care needs and how they are to be met. Comments received on our surveys include; ‘my mother always has carers near by, the home has supplied a frame for her and special equipment,’ ‘my father has many ailments. The Forbury are exceptional in dealing with him, encouraging and supporting him always well mannered and with good humour,’ and ‘I don’t think my mother could get better care anywhere than at the Forbury.’ Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 12 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 excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Each service user has a social care plan following on from a detailed life history. The service has made a significant improvement to the provision of activities for service users to pursue in their leisure time. Rotas showed that sufficient staff resources are provided to allow time for activities and stimulation. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 13 The home has a new hairdressing salon. The hairdresser was on site and discussions showed that the arrangements are very much welcomed by the service users. Service users are taken, where able, to the local shop to choose flowers for the dining room table. Regular service user meetings are held and minuted. Staff have forged relations with the local museum who visit the home and discuss with service users about their memories of living in Leominster. The service has excellent links with the local churches and enable service users to worship according to their need. Service users are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal. Regular drinks are available and staff were seen to make a cup of tea at any time when asked. Dinner parties are held for individual service users who invite their friends and family. Formal invitations are sent out, from the service user, with a separate menu and choice of wine. These courtesies show that staff are genuinely interested in the people they care for. Meal times are considered a social occasion. The information in the home states that breakfast is on demand. This was observed during the fieldwork visit to the home as service users were seen sitting having their breakfast as and when they had got up for the day. An assistant cook now works in the kitchen for 7 days a week. There is commitment to involving service users in menu planning and making sure that they are able to enjoy the food they prefer and like. The menu is varied, balanced and nutritious. Comments on our surveys include: ‘Breakfast is excellent, fresh fruit available all day,’ ‘The care home provides a happy, clean, tidy environment with lots of opportunity for different activities,’ and ‘We are given a newsletter to keep us up to date.’ Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 14 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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaint procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: The service has a complaints procedure that is up to date, clearly written, and is easy to understand. All surveys returned by service users stated that they would go to the manager, deputy or their keyworker if they had a problem. All expressed confidence that issues would be dealt with. Surveys stated that concerns spoken about by service users had been promptly dealt with and a satisfied outcome reached. As seen form the minutes, adult protection is discussed at service user meetings so that they are aware of the responsibility of the service in this area. A survey response to the question ‘Do you know who to speak to if you are not happy? Stated: ‘If there have been any problems the staff have dealt with them immediately.’ The policies and procedures regarding protection of service users are in place. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 15 Training of staff in the area of protection is regularly arranged by the home. Service users surveys stated that they are very satisfied with the service provision, feel very safe and well supported by staff. Comments received from relatives include: ‘The home always contacts me with updates,’ and ‘The service communicates well with service users and their families, wellbeing of service users is top priority.’ Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 16 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): Key Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence EVIDENCE: Areas for refurbishment are identified and plans put in place to deliver this. The home now has a new wet room and assisted bathroom, both with new equipment but still decorated to retain a domestic-style. Some bedrooms have been redecorated with involvement from the service users in choice of design. The home generally has a well-maintained environment, which provides aids and equipment to meet the care needs of the service users. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 17 They have the choice to bring personal items of furniture into the home as seen in those rooms entered. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The home is well lit, clean and tidy and smells fresh. Comments received from relatives include: ‘Mums room is spotlessly clean.’ ‘The home always looks clean and tidy and the residents look well cared for and clean, tidy and happy.’ Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 18 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): Key Standards 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 in the home are being trained and are in sufficient numbers to fulfil the aims of the home and meet the changing needs of service users. EVIDENCE: Services users surveys informed us that staff look after them well and are very kind. The manager encourages staff members to undertake qualifications, and recognise the benefits of a skilled, trained workforce. The service ensures that all staff receive relevant training that is focused on improving outcomes for service users. The service has a thorough recruitment procedure. The recruitment of good quality carers is seen by management as integral to the delivery of an excellent service. The service is highly selective, with the recruitment of the right person for the job being more important than the filling of a vacancy Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 19 The procedure is followed in practice as seen from the recruitment records of two new staff members. All was in place including criminal record bureau checks/work permits. NVQ training is high priority with over 50 of care staff having level 2. Comments received from relatives include: ‘The Forbury appears to be a ‘nice’ home with caring staff.’ ‘The staff are all first class, nothing is ever too much trouble.’ ‘All the staff are very good to all the people who live at the Forbury.’ Comments from staff included informed us that they feel supported by the manager and that they have all the training that they need to do their job. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 20 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): Key Standards 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits being developed, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The registered manager’s practice is service user focussed and shows a commitment to conducting regular service user meetings that are minuted. Advocates were used to complete CSCI surveys sent to the home. The registered manager is person centred in her approach and people say that she is very approachable. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 21 The deputy manager for the home demonstrated her knowledge about elderly care and how the staff interpret this into providing excellent outcomes for service users. Record keeping systems are good and improve as new formats are implemented. Staff have received all mandatory training and other specific to the service user group cared for. The home actively encourages service users who wish and are capable, to manage their own money and valuables, making sure they have the facilities to do this safely. The home has efficient systems to ensure effective safeguarding and management of service user’s money including records keeping. Service users have access to their records whenever they wish. Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 22 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 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forbury The DS0000024735.V359975.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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