CARE HOMES FOR OLDER PEOPLE
Fallowfield House Malvins Close Blyth Northumberland NE24 5HN Lead Inspector
Karena M Reed Unannounced 04 July 2005 10:00 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. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Fallowfield House Address Malvins Close Blyth Northumberland NE24 5HN 01670 356775 0191 237 7209 N/A Mrs M Powers 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) Mrs A Sobey CRH 12 Category(ies) of DE - Dementia (1) registration, with number DE(E) - Dementia over 65 (5) of places MD(E) - Mental Disorder over 65 (1) OP - Old Age (5) Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The registration DE is specific to a named resident. The CSCI must be notified when this person leaves the home at which time the registration will revert to OP(6). Date of last inspection 18/11/2004 Brief Description of the Service: Fallowfield House is a large, detached house situated in a residential area of Blyth in close proximity of the town centre and its facilities. It is accessible by public transport. The building is of an older style and does not provide a passenger lift to the first floor but some bedrooms are available on the ground floor for less ambulant service users. All bedrooms are for single occupancy. There is a large lounge and separate dining room to the front of the house overlooking the extensive gardens, and a smaller lounge to the rear. There are two bathrooms, one of which contains an assisted bath. The home is registered to provide personal care to twelve older persons, whose needs may include memory loss or mental health problems past or present. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over three hours. A partial tour of the premises took place and a sample of care records were inspected as well as other records. Records included: 5 care plans, 2 staff files, the fire log record, the accident book, admission/discharge register, complaints record, staffing rotas, daily communication book and service users personal allowance records. The proprietor, manager, hair dresser, night carer, a day carer and the chef were spoken to during the inspection. Time was also spent with 8 service users during the inspection. What the service does well: What has improved since the last inspection?
A new manager has been appointed. There is a commitment to training to ensure staff can meet the specialist needs of people cared for at the home. The National Vocational Qualification training programme continues and exceeds the minimum requirement with over 75 of staff having achieved NVQs at level 2 or 3. This means staff have a good grounding in the knowledge they need to provide care. Several staff members have followed an intensive course about the needs of people with memory loss in order to gain more insight into the care of people with dementia type conditions.
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 6 The environment is becoming better maintained and there is an on going programme of decoration and refurbishment around the home. 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. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.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 Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.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) 1,2,3,4,5 The process followed in the home does not ensure that potential service users are provided with formal details of the services the home provides which helps them to make an informed decision about coming to stay in the home. Service users care records showed the home receives comprehensive information when a referral is made. The information assists the home to carry out their detailed assessment prior to agreeing to admit people into the home to ensure that the home can meet their needs. There is a comprehensive training programme to ensure that staff are equipped with the necessary skills in order to meet the needs of the residents. EVIDENCE: Inspection of records for five residents showed that full assessments had been carried out prior to their admission. A relatively new resident confirmed that they had visited the home and received information verbally about the way it was run before moving in for a trial stay. The resident was also very happy with the care and attention received. A Statement of Purpose was available outlining the services provided by the home. This should be updated at least annually to include the most up to date
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 9 training provided to staff and to demonstrate that staff are equipped with the necessary skills to meet the specialist needs of some service users. Service users records did not contain written contracts between the home and the service user stating the terms and condition of residency, although more general contracts between the home and County Council were available on individual service users’ files. Service users have the opportunity to visit the home as many times as they choose to decide if they wish to live there. This may involve tea-time visits, day and overnight stays and can be accelerated to the pace of the service user. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 There are good arrangements in place to ensure that residents’ health and social care needs are met. Care plans contain comprehensive information to ensure that all health care needs are clearly addressed and to ensure that the staff team are fully informed and aware of the support they need to provide. EVIDENCE: Inspection of the records for a recent admission showed that an assessment had been carried out prior to their admission. This was combined with information received from the care manager’s assessment of the resident’s care needs. The resulting care plan recorded detailed information about the health and medical needs of the service user and the amount of staff intervention required in order to provide support. A new social assessment had been introduced which was detailed and allowed information to be collected from the service users and their families in order to ensure a relevant plan of social care needs was drawn up with service users. Service users have a choice of General Practitioner if they are unable to retain their own when they move into the Home. There was evidence that GPs and Community Nurses were regularly consulted for advice and treatment. Records
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 11 were available to show district nurses visit the home as required and service users are assisted to access chiropody and optical services at least annually or as often as required. Staff assist service users to receive support from relevant mental health departments, as necessary. These departments will also provide some training to staff about the specialist needs of service users. Staff receive training about medication before they are given the responsibility of administering it to service users. The medication system was not examined at this inspection. All of those residents spoken to, who could comment, said that they were treated well by the staff and well cared for. It was apparent during the inspection, that attention was paid to service users’ dignity and staff were seen to act respectfully at all times . Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The Home provides support to enable service users to access and use community facilities when possible eg leisure, health, spiritual and social needs. Meals are managed creatively and provide daily variation and interest for people living in the home. Social activities do not currently provide daily variation and interest for service users. Visitors are made welcome and staff support residents to maintain contact with family and friends as they wish. EVIDENCE: There is a limited programme of activities in place including: videos, sing-along, bingo, manicurist, dominoes. At the time of inspection the hairdresser was attending to a number of service users. Service users spoken to were not very aware or enthusiastic about the activities that were offered by the home. A varied programme was not available for people to take part in if they wished. Service users said they did enjoy the organized social evenings arranged by the home to the local pub for supper or musical entertainment. There was no evidence of regular meetings with service users although they did say they were individually asked their views and opinions almost daily.
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 13 Eight people living in the home were spoken to and those who commented on the food said how good it was. On the day of inspection, the lunch comprised shepherds pie, green beans and cauliflower followed by mince pie and brandy sauce, or spaghetti Bolognese and garlic bread followed by ice cream. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There is a suitable complaints procedure. Service users and their relatives have confidence that they can raise any issues and know that they will be dealt with. Staff have knowledge and understanding of Adult Protection issues which protects service users from abuse. EVIDENCE: The home has a complaints procedure. There have been no complaints about the home since the last inspection. The service users spoken to confirmed that they would raise any issues of concern with the staff team. A procedure for responding to allegations of abuse is available. The manager informed me that staff were to update their training in Adult Protection the following week. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 15 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) 19,20,21,22,23,24,25,26 The home was quite well maintained with good quality furnishings and décor in the communal areas, which creates a pleasant and homely environment for those living there. There is a quite a good standard of hygiene around the home. Systems are in place to provide a safe environment for service users and staff. EVIDENCE: A tour of the premises was undertaken and a small number of bedrooms viewed. The home is well maintained and the lounge has recently been decorated and refurbished. There are two lounges and a dining room. Service users bedrooms were personalized to their tastes. There are an adequate number of bathrooms with equipment to help those with physical disabilities and some separate lavatories around the home. The floor coverings around the lavatories in the upstairs bathroom and separate lavatory downstairs required replacing in the interests of health and safety. There are good laundry facilities in place and staff receive training about infection control. There are large, well tended gardens with pleasant sitting areas.
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 16 Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 17 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 Good staffing levels are maintained which means that there are enough staff on duty to meet the needs of service users. The staff have an understanding of the service users support needs.This is evident from the positive relationships which have been formed between staff and service users. There are training arrangements in place, which means staff are given a grounding in the areas they need to know to provide good care and enhance their personal development. EVIDENCE: Examination of staff rotas and discussion with the person in charge and members of the staff team provided evidence that the numbers of staff are as follows: 9.00am- 3.00pm 3 3.00 pm- 9.00pm 3 9.00pm-9.00am 2 This is for five days of the week. On two days of the week there are four staff members available during the day. These numbers include the manager who works some supernumary hours. There is a senior staff member on each shift. Other staff members are employed for duties such as food preparation, cleaning and gardening.
Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 18 The necessary checks are being carried out prior to the workers being appointed. There is a stable committed staff team and there is a low turnover of staff. Staff stated that they enjoyed working in the home and were observed to be kind, caring and respectful to residents. Staff stated that they receive induction training. Where new inexperienced staff are employed, they work as an extra member of the shift, which is good practice. 75 of the care staff team have now achieved National Vocational Qualifications at level 2 and 3. Staff confirmed that they also receive advice and /or training in other areas, such as challenging behaviour, care of people with memory loss, psychological research, mental health awareness. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 19 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) 31,32,33,34,35,36,37,38 The manager is new into post. She is planning to build on procedures to ensure the well running of the home and to ensure the safety of residents and staff that will compliment the existing systems. Records were well documented and statutory health and safety checks were carried out in the required time scales. EVIDENCE: A new manager, Mrs Diane May, has been appointed to manage the home. She has been acting as manager in the absence of the previous manager who has now resigned due to health reasons. The new manager has applied to be registered as manager. She is also studying for the Registered Manager’s award which should be completed by October 2005. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 20 The positive comments of service users and staff give confidence that the manager provides good leadership throughout the home and promotes a philosophy of involvement of service users and staff. Discussions with the manager and the staff records viewed provided evidence that the staff are supported in their roles through supervision every two months. There is a system in place to ensure that staff are given training in moving and handling skills, fire safety, first aid, infection control and good hygiene. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 4 3 4 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 3 3 3 3 3 3 Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 22 No 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 1 Regulation 4(1)(b)(c) 6(a) Requirement The Statement of Purpose to be reviewed and updated to include relevant staff training.Service user guide to be made available to all services users. A contract to be issued to all new service users detailing the services provided by the home and the fees payable. The floor coverings in the lavatories to be replaced. Timescale for action September 1st 2005 2. 2 5(b)(c) September 1st 2005 August 15th 2005 3. 19 13(4)(c) 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 To hold regular service user meetings to gather the views of service users about choice of activities. More detailed information should be available about the social care needs of individuals. This information would assist the home in providing activities within the home that service users may wish to participate in. Methods should be explored to consult with service users and provide choice eg activities, outings etc. The manager to obtain the registered managers qualification in 2005
B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 23 2. 31 Fallowfield House 3. Fallowfield House B53-B03 S520 Fallowfield House V231585 040705 Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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