Inspection on 01/06/05 for Fairburn Chase

This inspection was carried out on 1st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Fairburn Chase 24/04/07

Fairburn Chase 12/07/06

Fairburn Chase 09/01/06

Fairburn Chase 04/07/05

Fairburn Chase 11/11/04

Fairburn Chase 29/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Wheldon View Wheldon View Wheldon Road Castleford WF10 2PY Lead Inspector Gillian Walsh Mavis Pickard Unannounced 1 June 2005 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. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wheldon View Address Wheldon Road Castleford WF10 2PY 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) 01977 559703 01977 517664 Wheldon Health Care Ltd Care Home with Nursing 76 Category(ies) of Physically Disabled - 29 registration, with number Older People - 76 of places Terminally Ill - 2 Terminally Ill, over 65 - 2 Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 11.11.04 Brief Description of the Service: Wheldon View is situated on the outskirts of Airedale village and Castleford town centre with a limited access to Local shops although this is partly compensated for by the home having use of a minibus which is shared with two other homes in the same site. It is a purpose built home for 76 residents, 47 of whom are older people with the remainder of places being for Younger Adults with a Physical Disability. The home is registered for personal care and nursing beds. All bedrooms are single and offer en-suite facilities. There is a well-tended central forecourt garden for residents to sit out in the good weather. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by 2 inspectors, which lasted for 7 hours. On this occasion only the older peoples unit was inspected, an inspection of the younger adults unit will be made at a later date and that report should be read in conjunction with this report. At the time of the inspection the responsible individual was in charge of the home. Since the inspection the Commission has been informed that the registered manager is no longer employed at the home. The inspectors spent long periods of time looking around the unit, talking with residents, one relative, staff and the responsible individual. The unit was short staffed on the day of the visit and inspectors were concerned that several dependant residents were in their bedrooms situated a good distance from the main communal areas, which meant that staff’s observation of these residents was poor and three people were found by the inspectors to be needing assistance. Concerns were also raised about unsafe practices regarding medication and a poor standard of care planning within the files seen. The responsible individual was aware of several issues within the unit before the inspection and was in the process of organising audits of medication systems, care planning and areas of care practice. Environmentally the unit provides residents with appropriate and comfortable bedrooms although cleaning standards in communal areas need to be improved. Some residents said that staff were kind and caring in their approach and this was observed during the visit although there were also instances of a lack of respect for resident’s dignity needs. The responsible individual told the inspectors that she is committed to improving standards at the home and on the day of the inspection was arranging for senior staff from within the company to immediately audit and improve care practice within the home. The inspectors would like to thank residents, visitors and staff for their time and assistance during the inspection. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 6 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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 Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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 The home’s admission procedure does not prevent residents from moving into the home without having their needs assessed to ensure that staff will be able to meet these needs. EVIDENCE: On the day of the inspection a new resident was being admitted to the older peoples unit. Staff told the inspector that this person had not had a preadmission assessment as this had been scheduled for later that day. Staff said that the resident had been transferred to the home from the hospital without proper arrangements from the hospital and they did not know anything about his needs. The responsible individual said that this situation was unusual and would be investigated, as it is the home’s policy to always make a pre-admission assessment. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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) 7,9 and 10 Resident’s needs are not set out in current and up to date care plans. Shortfalls in medication systems have a potential to put residents at risk. Resident’s dignity needs is not always protected by staff. EVIDENCE: Care plans are in place for each resident but several care plan files contained incomplete assessments and care plans which had not been updated to reflect residents current needs. One file contained care plans relating only to mobility, personal care and behaviour, but the resident had specific needs in several more areas of daily living. Monthly reviews are not always taking place and none of the care plans seen, had been signed by the resident or their representative. A large number of blister packed medications were seen on a table in a lounge. Residents and visitors, including a small child, were in the room but the nurse was not in the area. Examination of systems for storage and administration of medications revealed a number of issues. Medications to be given later in the day had already been signed by a nurse as given and a tablet was found on the top of the bedside cupboard in a confused residents room. Several Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 10 medication stock balances were incorrect and MAR (Medication Administration Record) sheets did not give clear instructions about the dose of Warfarin to be given to one resident or when another resident was due to have their Fentanyl patch renewed. One resident told the inspector that they were upset and uncomfortable because after having waited a long time for staff to provide them with incontinence pads, the wrong ones had been left in the room and the resident had not been able to put the pad on properly and comfortably. Other examples of a lack of attention to residents dignity needs were, staff talking about one residents poor health in front of the resident, residents clothing not being arranged properly to maintain their dignity and one resident with a serious chest condition, having to wait in a corridor for a sputum carton. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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 and 15 Resident’s preferences with regard to social and recreational needs are not always recorded and recreational activities are not always available although contact with family and friends is encouraged. Residents receive an appealing balanced diet but mealtimes and residents access to drinks and snacks are not well organised. EVIDENCE: An activities organiser was on duty during the inspection but was occupied with assisting care staff to meet residents physical needs rather than conducting activities. The inspectors were told that this was due to staff shortages on the day. Care plans reflected some personal preferences but contained little evidence that resident’s recreational needs are considered. Several residents had visitors at various times of the day and those visitors spoken with said that they were welcomed at the home. Several residents said that the food at the home was “alright” and that they did get a choice of what to eat. One resident who was sitting at the dining table long after breakfast had finished, said that they had not had their breakfast yet and would like something to eat. Staff were unsure about whether or not this resident had eaten breakfast but one staff member said Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 12 that they had refused it. Another resident who was in their room alone told the inspector that they were thirsty, but as they were physically unable to use the call bell or could not access a drink without assistance. The lunchtime meal looked appealing and nutritious, but staff were struggling to meet the needs of those residents who needed assistance with their meal. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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 The responsible individual is working to ensure that complaints will be promptly and appropriately responded to. EVIDENCE: The inspector spoke with a visiting relative who had made complaints to the home regarding the care of their relative. This complaint had not initially been dealt with to the satisfaction of the complainant, but they were happy that their complaint was now being looked into and that steps were being taken to address the issues. The responsible individual told the inspectors that she was looking into why complaints had not been handled well at the home and was ensuring that this problem did not re-occur. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 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) 24 and 26 Resident’s bedrooms are comfortable and meet their individual needs although current cleaning routines are not adequate to provide residents with a clean environment. EVIDENCE: Residents have nicely furnished, en-suite, bedrooms which the majority have personalised with their own small pieces of furniture, photographs and other items. Generally the home was tidy although there were some communal areas, particularly bathrooms, which were in need of more thorough cleaning. Several chairs and wheelchairs were dirty with crumbs and food spillages and the lifting hoist was also dirty. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 15 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 and 29 The deployment and number of staff available are not sufficient to meet the needs of residents. The procedures for recruitment of staff provide safeguards to people living at the home. EVIDENCE: One resident said that staff were kind but they were so busy that if the resident asked for something they had to wait a long time before they got it. Another resident said that when they called for staff, they sometimes came to their room and put their hand around the door to turn the call bell off without asking the resident how they could help. During the visit, some residents were seen to be in need of attention from staff but were having to wait. Care staff said that due to sickness they were two staff short on the morning shift and were struggling to meet the needs of all the residents. The nurse in charge was one of the home’s bank nurses, but said that they did not do regular work on the unit and was therefore unfamiliar with residents needs. The Commission for Social Care Inspection had recently given the home a notice of requirement regarding recruitment practices, which has resulted in a full audit of staff personnel files. The files checked during the visit indicated that the home’s recruitment practices now protect resident’s safety. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 16 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 and 33 The home does not have a manager at the moment but arrangements are in place to ensure that the home runs in the best interests of residents. EVIDENCE: At the time of the inspection the company was reviewing management arrangements at the home. Since the inspection the company has informed the Commission for Social Care Inspection that the manager is no longer employed at the home. Arrangements are in place for the home to be managed by senior personnel from the company until a new manager is recruited. Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 17 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 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION x x x x x 3 x 2 STAFFING Standard No Score 27 1 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x x Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 18 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 3 Regulation 14(1) Requirement The registered person shall not provide accommodation to a service user at the care home unless the needs of the service user have been assessed by a suitably qualified person and the registered person has recieved a copy of this assessment. Unless it is impractical to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. This requirement has been brought forward from the previous two reports. The original timescale was 30 September 2004. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medications received into the care home. This requirement has been brought forward from the previous two reports. The Timescale for action From next proposed admission to the home and ongoing From 1.6.05 2. 7 15(1) 3. 9 13(2) From 1.6.05 Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 19 4. 10 4(a) 5. 27 18(1) original timescale was 29 June 2004. Suitable arrangements must be made to ensure that the home is conducted in a manner which respects the privacy and dignity of service users. This requirement has been brought forward from the previous report. The original timescale was 17 November 2004. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 31 July 2005 From 1.6.05 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. Refer to Standard 12 Good Practice Recommendations A programme of activities should be in place to meet the recreational and social needs of residents. Residents preferences regarding their lifestyle should be included within their care plan. Serving of meals, drinks and snacks should be better organised to ensure that residents are not hungry or thirsty. Cleaning routines should be improved to ensure that the home provides residents with a clean environment. 2. 3. 15 26 Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 20 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse. HD6 4AB 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 Wheldon View J51J01_s6266_Wheldon View_v230249_010605.doc Version 1.30 Page 21 - 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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