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Inspection on 26/08/05 for Eastfield Farm Residential Home Limited

Also see our care home review for Eastfield Farm Residential Home Limited for more information

This inspection was carried out on 26th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is good rapport between staff and managers and this creates good teamwork. Staff are offered regular training opportunities and this has resulted in a skilled workforce. Service users speak very highly of the staff and it is evident that service users receive a high standard of care. One service user said `the food is great`.

What has improved since the last inspection?

Staff have undertaken training on the protection of vulnerable adults from abuse and this has increased staff awareness. Improvements have been made to records held in care plans of a service user`s health care needs and how these are met.

What the care home could do better:

More care needs to be taken with recording when service users do not take their medication.

CARE HOMES FOR OLDER PEOPLE Eastfield Farm Residential Home Ltd Halsham East Yorkshire HU12 0BP Lead Inspector Diane Wilkinson Unannounced 26 August 2005 th 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 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. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Eastfield Farm Residential Home Ltd Address Halsham Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01964 671134 Eastfield Farm Residential Home Limited Maureen Ann Whiteley Care Home 25 Category(ies) of OP Old Age (25) registration, with number DE(E) Demential over 65 (25) of places Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15 March 2005 Brief Description of the Service: Eastfield Farm Residential Home is a privately owned care home that is registered to care for and accommodate 25 older people, including those with dementia. The home is situated in a rural setting and local amenities are only accessible via public transport or car. The accommodation comprises of seventeen single rooms and four shared rooms - eleven of the single rooms and one of the shared rooms have en-suite facilities. The first floor is accessible via a stair lift. Communal space comprises of three lounges and a dining room - some of these areas have open views over the countryside. The garden is easily accessible for service users and in the summer benches, tables and parasols are placed outside. There is ample parking space at the front of the building. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours, including preparation time for the inspector. The inspection included a tour of the premises and examination of documentation, including care plans. The inspector spoke to several service users (some on a one to one basis), staff and the registered manager. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users are assessed prior to any decision being made about admission to the home and admission only proceeds if their needs can be met. EVIDENCE: Service users are assessed prior to their admission to the home and discussions take place with the service user (if possible), care management, health professionals and relatives/friends as part of the pre-admission process. Service users are visited at home whenever this is feasible and are encouraged to visit Eastfield Farm if they are able to do so. The community care assessment and care plan developed by care management is obtained and is used as part of the assessment process and to commence the care planning process. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 There are systems in place to ensure that a service user’s individual care plan is reviewed regularly, ensuring that current care needs are met. Health care needs are well met by staff at the home. The systems for the administration of medication are good but more care needs to be taken with recording to ensure that there is an accurate record of medication taken by service users. Service users informed the inspector that they are treated with respect at all times. EVIDENCE: Care plans now include information about how a service user’s needs should be met by staff, including challenging behaviour or deteriorating health. Care plans are reviewed monthly by staff at the home and formal reviews are undertaken by care management – these are attended by service users whenever this is possible. Some staff have undertaken training on risk assessment and this has resulted in thorough and meaningful risk assessments being in place for service users. There are risk assessments in place for pressure care, the risk of falls, memory impairment and more individual risks, and these include details of control measures that are in place. Some of these are stored separately to the care plans and it would be preferable for all of this Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 10 documentation to be held in one place. There is some evidence that service users are aware that there is a care plan in place and that they are able to help develop their plan of care. Health care needs are well met by the home. Service users are weighed as part of nutritional screening – when it is not possible to weigh service users an alternative method is used. Risk assessments and other records that are in place about a persons need for pressure care are reviewed ensuring that the care plan contains up to date information. Pressure care equipment is provided by the home and pressure care offered by staff is of a high standard, for example, regular ‘turning’ and getting service users up to relieve pressure areas. Continence care is appropriate. Some service users have mental health treatment plans in place and psychological health is monitored. Many care staff have undertaken training such as catheter care, pressure ulceration awareness and the fitting of incontinence products. The district nurse visits the home on a daily basis to assist with pressure care for service users. A record is kept of visits from GP’s and other health professionals in a separate book – the inspector recommends that this information is also recorded in service user files. The inspector observed medication being given to service users at lunchtime – this was administered in a satisfactory manner. There are some gaps in the recording of medication when service users refuse medication or are asleep – more care needs to be taken with this. There is a list of staff that are responsible for the administration of medication – some of these have undertaken accredited medications training and others are due to commence this training in September. Ideally staff should undertake accredited training before they begin to administer medication. There are satisfactory policies and procedures in place. Service users informed the inspector that they are treated with dignity and respect at all times. Staff knock on bedroom doors before entering and assist with personal care in a sensitive way. Most service users have a single room so that they can meet with health professionals, family and friends in private, and there are also private areas around the home. There is a statement about client confidentiality in all staff files. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Service users are supported and encouraged to maintain their chosen lifestyle following admission to the home, and to maintain contact with family and friends. Service users are encouraged and supported to make informed choices. Meal provision at the home is good but staff should ensure that service users are aware that there is an alternative to the main meal on offer. EVIDENCE: A service user’s choices for daily living are now recorded in care plans, for example, chosen times to get up and go to bed, where a service users likes to spend the day and where a service user likes to have their meals. Service users informed the inspector that they are able to follow their interests when they are admitted to the home, and that they enjoy entertainment organised for them. Service users were seen to be reading, writing letters and doing crosswords. There is a fish tank in one of the lounges. Many of the service users like to sit in the lounges that face open countryside and watch the comings and goings at the adjoining farm. Some service users choose to spend the day in their bedroom and are happy to listen to music and videos, and watch their own TV. Some service users are happy to sit with friends or to spend time chatting to staff. A record is kept of activities undertaken by service users in the home – the inspector recommends that this record is held in service user files rather than in a separate record. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 12 Care plans and discussion with service users and staff evidence that family and friends are encouraged to visit the home. Service users state that their visitors are always made welcome. Service users informed the inspector that they are encouraged and supported to make decisions about their day-to-day lives. Details about advocacy services are displayed in the home. Service users are supported to handle their own financial affairs for as long as they are able to do so. No service user monies are handled by the registered persons – this is undertaken by family and friends if a service user does not have the capacity to do so. Bedrooms have been personalised by service users and some people have brought small items of furniture into the home. An inventory is kept of items brought into the home by service users. Service users report that meals at the home are good. Service users were seen to be supported appropriately to eat their meals – service users can choose whether to eat their meals in the dining room, one of the lounge areas or in their bedroom. One service user was seen to have an alternative to the main meal on offer. Service users are informed on the day of the meals to be served. Some service users did not seem to know that there is a choice of meal at lunchtimes, but all agreed that there is a choice at teatime. The inspector recommends that it is made clear to service users that there is a choice of meal on offer at lunchtime, and that a menu is displayed to encourage independence for those service users who could view it. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Service users know how to make a complaint to the home, and are confident that their complaints will be listened to and dealt with appropriately. There is evidence that staff are aware of and follow policies and procedures in place to protect vulnerable service users from abuse. EVIDENCE: There is an appropriate complaints procedure in place – this is displayed in the home and is included in the statement of purpose. There is a complaints log in use – this was examined by the inspector and evidences that complaints are dealt with satisfactorily and that complaints are well recorded. Service users informed the inspector that they know how to complain and are confident that any issues would be dealt with effectively. There are appropriate policies and procedures in place, including the protection of vulnerable adults from abuse, whistle blowing, restraint and bullying. There is now a policy in place on the protection of service user monies and financial affairs. Training records evidence that most staff have attended training on the protection of vulnerable adults from abuse. There have been no recorded allegations or incidents of abuse at the home. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Service users live in a safe, well-maintained and homely environment. The home was clean and hygienic on the day of the inspection. EVIDENCE: The location and layout of the home is suitable for its stated purpose. The home has a comfortable homely appearance and furniture and fittings are domestic in nature and of good quality. The home is well maintained – there is the broad outline of a maintenance programme recorded in the business and financial plan. A log is kept of all maintenance undertaken. The lounges and dining room at the front of the home allow views over the attractive garden and open countryside, and allow plenty of access to sunlight. There are no CCTV cameras in use at the home. The issue about the keypad on the front door has been addressed – the inspector saw a letter from the Fire Officer. There is a large rug in one of the lounges that has a frayed edge - this is a trip hazard and should be removed. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 15 The home was clean on the day of the inspection and a member of staff was seen to be cleaning communal and private areas of the home. Laundry facilities meet the requirements of this standard. Staff were advised to label the sink in the laundry room to make it clear that it should only be used by staff to wash their hands, and not for sluicing. Most staff have undertaken training on infection control. The inspector noted that all staff carry around with them an antibacterial hand cleaner – this is very good practice. One or two bedrooms have a slight odour but it is evident that action is being taken to alleviate this problem – carpets are cleaned regularly and windows are left open so that fresh air can help to get rid of odours. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staffing levels ensure that service users are safe, and that the premises are clean and hygienic. Recruitment policies and practices at the home do not currently ensure the safety of service users. There is appropriate staff training taking place that ensures the health, welfare and safety of service users. EVIDENCE: There is a satisfactory staff rota in place. This records ancillary staff as well as care staff. On the day of the inspection the home was ‘short staffed’ due to staff sickness and holidays, i.e. there were three care staff on duty instead of the six staff recorded on the rota. The registered manager had tried to arrange for other staff to cover these shifts but had been unsuccessful. The registered manager was therefore working as a member of care staff on that day. The inspector observed that, although care staff had to work very hard, the needs of service users were met. This was made easier because there was a cook and a domestic assistant on duty. The afternoon shift was fully covered. It is expected that nine care staff (about 33 ) will have achieved NVQ Level 2 in Care by the end of 2005. More staff have enrolled for this award so the 50 requirement should be achieved some time next year. New staff at the home complete an application form that includes a history of their previous employment. Appropriate induction takes place and this meets Skills for Care (previously TOPSS) specifications. There is evidence that some Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 17 staff commence work at the home before two written references and a satisfactory CRB check have been obtained. All staff receive a statement of terms and conditions. There is a card index system in place that records all of the training undertaken by staff. Staff have undertaken ‘core’ training and some specialised training, such as risk assessment. Training certificates are held in staff files and are displayed around the home. A Skills for Care information leaflet was displayed in the home. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 & 38 The home is managed by a skilled and experienced manager. There are quality systems in place to enable service users and others to express their views on how the home is run. The health, safety and welfare of service users is protected by the systems that are in place. EVIDENCE: The home is managed by a skilled and experienced manager and there is evidence that managers and staff ensure that their practice is kept up to date. The registered manager is a nurse but does not intend to undertake NVQ Level 4 in Management. There are clear lines of accountability within the home – the deputy manager is undertaking specific management duties as part of her training to take over as registered manager when the existing manager retires next year. The deputy manager has achieved NVQ Level 3 in Care and has enrolled for NVQ 4 training to commence in September 2005. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 19 Service user questionnaires were sent out in March 2005 and many have been completed and signed by service users. The information gained from these surveys has been collated and is to be published shortly. Questionnaires were sent out to health professionals in May 2003 and 2004 and are due to be repeated. There is a business plan in place for the years 2005 to 2010 and this addresses some quality issues. Policies and procedures are reviewed periodically to reflect good practice guidelines and changes in legislation. No monies are held on behalf of service users. Some service users handle their own financial affairs and relatives handle the affairs for other service users. There are policies and procedures in place about gifts and about the handling of service user’s monies. There are satisfactory arrangements in place to ensure the health, safety and welfare of service users. There is a fire risk assessment in place and this was reviewed in February 2005. The fire alarm system was checked by a qualified contractor in April 2005 and in-house fire tests and drills are satisfactory. Information is held about COSHH and these products are stored securely. The stair lift was serviced in January and April 2005. The four mobility/bath hoists used in the home were serviced in May 2005. A portable appliance test took place in July 2005. Staff undertake health and safety training at the induction stage and then on an on-going basis. Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x 3 x x 3 Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 21 Yes 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. 1. Standard 29 Regulation 18 & 19 Requirement Two written references and a satisfactory CRB check must be obtained before staff commence work at the home. Timescale for action Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 7 9 15 19 28 31 Good Practice Recommendations Risk assessments and a record of visits from health professionals should be held with other care planning documentation. More care must be taken to record when service users do not take medication, and for what reason. It should be made clear to service users that there is a choice of main meal at lunchtimne. A menu should be displayed. The rug that is a trip hazard should be removed. NVQ training should continue to ensure that 50 of staff achieve NVQ Level 2 in Care. There should be a registered manager in post who has achieved NVQ Level 4 in Care and Management by the end of 2005 Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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 Eastfield Farm Residential Home Ltd 20050826 Eastfield Farm Residential Home Ltd IR J53 v228619 s62571 Stage 4.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!