Care Home: The Foxwalls

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What the care home does well The Foxwalls is located on the edge of the town of Stafford, it has some garden space one which is enclosed for the safety of the people using the service. The service provides an exceptionally well furnished establishment with quality furnishing and fittings that are colour co-ordinated. Arrangements were in place for the continued health care of individuals with the general practitioner, consultants and district nurses. The AQAA told us that all the staff were trained to a high standard to enable them to have the ability and knowledge to provide high quality personalised care. The staff were evidenced to be sensitive and knowledgeable about the needs of individuals. The `Have your say` surveys were very positive about the staff. `The staff are brilliant and the care is second to none`, `The staff are always caring and responsive`, `Staff well trained, polite always helpful and willing to listen`. What has improved since the last inspection? The AQAA told us the service has introduced a `staggered` lunchtime routine to enable the staff to give one to one care to people with dementia who need assistance when dining. The service was purchasing special crockery to assist at meal times ensuring the dignity of individuals. The rotas have been implemented to ensure that there will be adequate staff on duty in an evening as well as the day shift. What the care home could do better: Care plans seen were incomplete this included the new format to be used by the service. Failure to have completed care plans could result in individuals needs and expectations not being fully met. The service was providing a facility to enable people discharged from hospital to return to the community. This service is not in line with the National Minimum Standards by providing the appropriate equipment such as designated space and staff training. To enhance the safety practices for the service prescribed creams when opened should be dated, addition information to where the cream was to be applied can be added to the medication record. The AQAA in parts did not provide sufficient information enabling us to have a full overview of the outcomes for people. All the people using the service for re-ablement,this is a service for people discharged from hospital to enable them to return to the community. Each person is required to have a full assessment by the service thus ensuring the needs of individuals can be met. Lack of an assessment and inconsistencies could result in the service not being appropriate and peoples needs not being met. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Foxwalls Marston Road Stafford Staffordshire ST16 3BU     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: Wendy Grainger     Date: 1 3 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 27 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 27 Information about the care home Name of care home: Address: The Foxwalls Marston Road Stafford Staffordshire ST16 3BU 01785255118 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Staffordshire County Council, Social Care and Health Directorate care home 48 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 32 12 7 16 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 4 0 0 0 (DE) - 3 Both sexes - Minimum age 50 years on admission Date of last inspection Brief description of the care home The Foxwalls is a purpose built Local Authority home that provides a service for 39 older people. The home had being extensively altered and was now offers accommodation for 48 older people. The home is owned by Staffordshire County Council and operated by Staffordshire Social Services. The home is located in a residential area of Stafford and is close to amenities and served by public transport. The home is pleasantly situated with lawns and external sitting area. Adequate car parking, external roadways and pathways are provided. The fees quoted applied at the Care Homes for Older People Page 4 of 27 Brief description of the care home time of the inspection were from £373-£658. People may wish to obtain up to date information from the service Care Homes for Older People Page 5 of 27 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: This unannounced key inspection was carried out by one inspector between the hours of 7am and 3:30pm who used the National Minimum Standards for Older People as a basis for the inspection. Prior to the inspection we had sent an Annual Quality Assurance Assessment (AQAA) for the management to complete, this was returned to us prior to the visit and within the requested timescale. The document in sections did not always provide in depth details required. The completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are being met for the people who use the service. It also gives us some numerical information about the service. Care Homes for Older People Page 6 of 27 We were provided with documents which included menus, care plans, medication records and financial details. We spent some time looking round the premises speaking and observing the staff and people using the service. We were told in the Have your say surveys,which are surveys sent to various people including the people using the service and staff to obtain feed back of the outcome of the service. I have nothing but admiration for all the staff who even working under such stressful circumstances are able to do it and remain cheerful. What the care home does well: What has improved since the last inspection? What they could do better: Care plans seen were incomplete this included the new format to be used by the service. Failure to have completed care plans could result in individuals needs and expectations not being fully met. The service was providing a facility to enable people discharged from hospital to return to the community. This service is not in line with the National Minimum Standards by providing the appropriate equipment such as designated space and staff training. To enhance the safety practices for the service prescribed creams when opened should be dated, addition information to where the cream was to be applied can be added to the medication record. The AQAA in parts did not provide sufficient information enabling us to have a full overview of the outcomes for people. All the people using the service for re-ablement,this is a service for people discharged from hospital to enable them to return to the community. Each person is required to have a full assessment by the service thus ensuring the needs of individuals can be met. Lack of an assessment and inconsistencies could result in the service not being appropriate and peoples needs not being met. Care Homes for Older People Page 8 of 27 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 27 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 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident they will be given relevant information to establish the services ability to meet their assessed needs Evidence: The Statement of Purpose does not fully reflect the service provided ensuring the home is suitable to meet their need. Ensure that the overall service provided is presented to people wishing to access the service. No person should be admitted without a full assessment of their needs, ensuring that at all times the staff were aware from completed care plans that the appropriate care is provided. Failure to have all the relevant information collated for the staff to access could put the people and staff at risk. The service does not have the appropriate facilities to provide re-ablement to meet the peoples assessed needs such as. Dedicated space, appropriately trained staff to use techniques including the treatment and recovery programme. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 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. Arrangements were in place for the service to meet the emotional, health and personal needs of the people using the service. Records were not always supportive of the care provided. Ensuring all aspects of care are met. Evidence: Care plans were evidenced to be incomplete in areas of personal care. The service had commenced re-ablement to support people and to encourage them to return home after a period in The Foxwalls. A qualified person needs to be part of the assessment process, ensuring the placement is appropriate with a positive outcome for individuals. Care plans were in the process of being changed to include a section with the help of family and friends My story where possible people using the service are involved. This section will assist staff to respond to the individual with a fuller knowledge of their past. The staff were seen and observed to assist individuals in a sensitive and relaxed manner, they responded to the needs of individuals. Staff promoted the self esteem Care Homes for Older People Page 13 of 27 Evidence: for one person during the day, because of her personal care needs she was seen to be wearing alternative clothes throughout the day. Completed Have your say surveys told us I have nothing but admiration for all the staff who even working under stressful circumstances are able to remain cheerful, Staff are well trained, polite and always helpful and willing to listen. Medication administration by the trained staff was observed, which gave us no concerns. Staff told us I have recently completed my medication training this was confirmed from the staff training records. We asked staff where administer prescribed creams were to be applied,there was no guarantee that preparations would consistently applied if this practice was not written on the medication record. The service provided the appropriate storage facilities for medication. Arrangements were in place for the continued health care for individuals. At the time of the inspection there was minimal involvement from the district nursing service. People where necessary have arranged visits to meet their needs.The service had a number of general practitioners available to the people. Care plans seen evidenced that people had their health needs met. We observed staff during the inspection knock on doors respecting the privacy of individuals. At this time the people using the service have the choice of male and female carers. Ensuring personal preferences for care are respected at all times Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people are supported by staff in their daily life style and routines. Routines were based on choice and meals are appropriate to meet their needs. Evidence: The service had recently undergone changes for the provision of care to more dependent people. These changes within the service has meant that the activity programme had been restricted. This we were told in the AQAA had started to increase with new staff and ideas for each unit. We evidenced notices for the nail bar,. Staff told us, This has been very popular with the people people spoken to also confirmed this. We go out to a pub or somewhere for lunch. One of the care plans showed activity, which the person had been involved in including darts and dominoes. Entertainment was planned for 5pm on the day of the inspection when a choir would come to sing. Later in the month an entertainer will be visiting the service. Spiritual needs are recognised and respected by the management, personal arrangements can be made by individuals. We evidenced breakfast and lunch meals were well presented and we were made aware by staff that they were of a portion to suit individuals preferences; the Have Care Homes for Older People Page 15 of 27 Evidence: your say surveys told us that The food could be better. We were provided with the menus that displayed a balanced and varied diet. A pictorial menu is being developed to assist in an individuals choice of meals. We were told by one person that he had Enjoyed his lunch its always good and plenty of it. The service monitors peoples nutritional requirements, if necessary the service have access to a dietitian. Assessed needs to promote independence the service would provide specialist crockery, and utensils. Previously the service has provided with advice if necessary specialist dietary foods. The staff assisted the people with meals in a sensitive manner, encouraging them to try the meal. We were told by one relative that They are so good with mum they coax her, it gives me peace of mind to know she is well looked after. Care Homes for Older People Page 16 of 27 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. The people were protected by robust policies, staff awareness and training. Evidence: The AQAA showed there had been no complaints raised with the service or commission since the last inspection visit. The service has one outstanding safeguarding issue, which had been referred to the safeguarding team following the policy and procedures for the service. This has been on going for over twelve months and was reaching a conclusion. Safeguarding is where an allegation of abuse has been made or where care practices may compromise peoples health and safety. The Have your say surveys completed and returned to us confirmed people using the service and relatives were aware of the process to raise a concern. The complaint process details were displayed on the notice boards in each unit and in the entrance hall. The service is to develop a pictorial procedure enabling more people to understand the process. Staff had access to the in-depth policies and procedures, this was evidenced during the inspection with a person commencing her induction by spending time reading polices and procedures. This provided her with an insight to the structure and working practices for the service. Staff spoken to said they were aware of the process of making a complaint they were aware of the whistle blowing policy. They would report any concerns to the manager or the commission. This means that people can be assured they are protected at all Care Homes for Older People Page 17 of 27 Evidence: times. Care Homes for Older People Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides an exceptionally clean,safe and homely environment for the people using the service. Evidence: Located on the edge of the town of Stafford, The Foxwalls is a single storey purpose built establishment. We looked at the premises, which was a credit to the housekeeping staff. We evidenced fresh pressed linen on the beds, and a tidy, clean environment. The completed Have your say surveys confirmed that the service is always clean. One survey felt that Some bedrooms were in need of decorating and some were small in size making the use of a walking frame difficult. Windows in two units were to be lowered enabling people to have a better view of the gardens and community. One of the un-used bathrooms will be refurbished and a shower room created. This is proposed to provide more facilities while enabling individuals to have a larger choice for personal care. We were told that there were plans to create a sensory garden courtyard area later in the year. The appropriate steps will be taken to ensure the area is accessible enabling people to have the option to sit outside. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and the staff are well trained to support the people using the service ensuring their safety and appropriate care. Evidence: The AQAA told us training was on going, this was evidenced from the training matrix. We saw and staff confirmed to us that they had received training in safeguarding and dementia. One staff member said Since the home has changed I have just had more dementia training because we have more people with dementia now. We were told that sometimes courses i.e Protection of Vulnerable Adults were filled before they had a chance. This was discussed with the care manager who provided written evidence of no places available. The management ensured that during supervision and staff meeting that knowledge was cascaded to the staff. Staff confirmed that supervision was on going and relevant to their role as carers. We were told by one staff that I would not hesitate to follow the whistle blowing or complaints procedure, the people are the most important. Staff files were satisfactory with the appropriate checks and documents required prior to employment. which included a Criminal Records Bureau, Protection of Vulnerable Adults, and two references. The service had a robust recruitment for the employment of all staff since the last Care Homes for Older People Page 21 of 27 Evidence: inspection the service has had a total of seven staff leaving employment with twentytwo new staff being employed. Care Homes for Older People Page 22 of 27 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 service is operated to the best interest of the people using the service by a qualified competent manager. Evidence: The management team hold a number of personal monies for the people using the service three monies were checked at random and found accurate. Documents evidenced that equipment; electrical and portable were serviced to meet the manufactures guidelines this included: gas, hoists, heating system, portable equipment. thus ensuring that peoples health and safety was protected. The care manager had been in the caring profession for a number of years she has numerous qualifications including the Registered Managers Award NVQ level 4. Her knowledge is updated and refreshed with current training and legislation. So if these learnt skills are put into practice it should ensure that peoples choice, rights and care needs are assured. She has a relaxed style of management and operates and open Care Homes for Older People Page 23 of 27 Evidence: door which was confirmed by staff who felt comfortable speaking to her. We were told I know that if I had to discuss anything I would go to the manager her door is always open, I can always speak to any of the managers even if my supervision is not due. Since the last inspection there had been a change in the management team with new staff. We were told that the team was working well together. Monthly and six monthly audits of the quality assurance, policies and practices including records are carried out by the management and other people responsible for the service. These are audits carried out by line manager to the service, the management of the service to ensure the quality service provided to ensure peoples assessed needs are met. They include, medication practices, environment, an overview of the service from surveys by the people, staff and relatives. This information is collated and used to enable the service to move forward. The Have your say surveys told us,Staff are well trained ,polite always helpful, The service cares and looks after my mother who is vulnerable and frail and it does it supremely well, I feel very lucky to find a place in such a caring establishment all the staff do a superb job, Care is second to none. Care Homes for Older People Page 24 of 27 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 25 of 27 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 3 14 Needs assessments were not 10/06/2009 always undertaken. this may compromise the care provided to people. Action must be taken to ensure the service establishes peoples care and social needs 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 2 6 7 To ensure appropriate equipment is provided so that people can be confident their assessed needs can be met. To ensure care plans tell staff about peoples care needs and how to meet them. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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