CARE HOMES FOR OLDER PEOPLE
Fazakerley House Park Road Prescot, Knowsley Merseyside L34 3IN Lead Inspector
Daniel Hamilton Unannounced 27 April 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. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Fazakerley House Address Park Road Prescot Knowsley Merseyside L34 3IN 0151 289 9203 0151 477 9208 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) Meridian Healthcare Ltd Cathrine Atkinson Care Home 24 Category(ies) of (OP) 24 (PD(E)) 24) registration, with number of places Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. 2. Variation to admit one named service user under pensionable age. Date of last inspection 16 December 2004 Brief Description of the Service: Fazakerley House is a care home which is registered to provide personal care and support for up to 24 older people, including older people with a physical disability. The home is a purpose built building that is currently undergoing major building / refurbishment work to increase the number of bedrooms from 24 to 30 and to improve the overall environment for residents. It is located in the Prescot area of Liverpool and is easily accessible from the M57. Local shops, bank and public transport are situated aproximately half a mile away. Presently, the home offers a large amount of communal space as well as bedrooms. A smoking lounge is provided on the ground floor along with the offices, kitchen area, dining room and a selection of bedrooms. The upper floor, which can be accessed by a lift, comprises of the rest of the bedrooms. The more dependent service users are located in this area. Toileting and bathing facilities are located throughout.. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and included a complaint investigation. Brief details of the complaint and findings are included in the section entitled ‘Complaints and Protection’. During the visit, a partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The operations manager, home manager, care coordinator, two of the day and three of the night staff, eight of the twenty residents and one relative were spoken to during the visit. Leaflets were also left in the home to enable residents and others to comment on the service provided. What the service does well: What has improved since the last inspection? What they could do better:
Assessments of need must be kept under review, to ensure the needs of residents are identified. This is particularly important when a resident has experienced a change of circumstances. Likewise, care plans must be reviewed on a monthly basis and detail all the needs of residents and the support
Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 6 required by staff. Risk assessments must also be completed and associated management plans implemented where necessary, to eliminate unnecessary risks to the health and safety of the people living in the home. Although a range of nutritious meals was provided, some residents expressed concern about the lack of choice available. Comments included “I can’t say there is a choice of food, they bring the food to you” and “the meals are quite reasonable but we all get the same really.” Residents should be provided with a daily choice of meals, as detailed on the menu. The home should obtain the views of residents via individual and group discussions and minutes should be maintained. All complaint information must be recorded by the home and acted upon, to ensure any issues of concern are appropriately resolved to the satisfaction of all parties concerned. The furnishings in some bedrooms were in need of refurbishment, to ensure residents live in a well-maintained environment. This will be addressed over the coming months, as the home was in the process of being refurbished / redeveloped. Due to building work, two toilets had been temporarily taken out of use on the upstairs level, leaving only one toilet in operation for twelve residents. This must be addressed. Staff must complete all the safe practice training, to ensure competency in their roles and 50 of the care staff should have a National Vocational Qualification at Level 2 or equivalent. As the home is in the process of increasing its bed capacity, sufficient domestic hours must be available to ensure the home is maintained in a clean and hygienic state. In order to ensure health and safety, a maintenance certificate for the fire alarm system must be obtained and a fire risk assessment completed. Furthermore, water temperatures should be monitored and night staff should receive fire instruction training every three months. 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. Fazakerley House CS0000062027.V223388.R01.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 Fazakerley House CS0000062027.V223388.R01.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 and 3 Prospective residents were provided with information to enable them to make an informed choice about whether the home was suitable for them. Assessment information was not kept under review, to ensure the needs of residents were identified. EVIDENCE: A statement of purpose and service user guide had been produced for prospective residents since the last inspection. Two residents spoken to had recently moved into the home and were able to confirm that they had been provided with information about the home. Individual assessment records were kept for each of the residents. Three assessments were viewed, two were for recent admissions and one was for a resident who had been living in the home for over a year. Assessments were in place, however one resident had been admitted to the home without an up-todate assessment of need and there was no evidence that the assessment was being kept under review, despite the resident’s needs and environment having changed. Fazakerley House CS0000062027.V223388.R01.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, 8, 9 and 10 Care plans did not detail all the needs of residents. This has the potential to place residents’ health and welfare at risk. Medication was appropriately managed and safeguards were in place to protect residents responsible for their own medication. Care was provided sensitively, in accordance with the expectations of residents. EVIDENCE: Individual plans of care were available for each resident. Three care plans were viewed which were basic, did not detail all the health, personal and social care needs of residents or the support required by staff. This was particularly evident for one resident who was at risk of falling, incontinent and who had difficulty understanding changes to the environment. There was no record of these needs or any risk assessment and associated plan. One plan had not been reviewed on a monthly basis. Staff spoken to had a good understanding of how to promote and protect the rights of residents. Comments from residents included; “the staff are very good and treat you well”, “they’ve got respect for you” and “you get treated with privacy and dignity.” Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 10 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) 15 Daily choices of meals were not always available, however nutritious meals and special diets were provided, to ensure residents received a wholesome balanced diet. EVIDENCE: A number of residents were spoken to about the meals in the home. Overall, residents were satisfied with the quality of the meals provided. Most residents reported that there was a lack of choice available, especially for dinner. Comments included; “I can’t say there is a choice of food, they bring the food to you”; “the meals are quite reasonable but we all get the same really” and “there is a choice for tea time only.” This situation was also found at the last inspection visit, when a recommendation was made to consult residents in developing menus to show appropriate choice. Menus were inspected and found to be balanced and interesting and an alternative was recorded for lunch. The menus were updated during the inspection, to include a choice for all teatime meals. A meeting had been arranged during January 2005, to consult residents about changes to the menu. The menu changes had not been offered to residents at the time of the visit. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 11 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 Complaint information was not always recorded and some relatives were not confident that their complaints would be acted upon. Safeguards were in place to protect residents from abuse. EVIDENCE: The home had a complaints procedure and a record of complaints. The complaint record showed two complaints had been received since the last inspection. One complaint concerned a meal and the other was about a drink of tea. In both cases, the home responded promptly, to resolve the complaints. One complaint had been received by the Commission and was investigated during the inspection. The complaint was from a relative regarding an accident that had occurred in the home, which had resulted in an injury to a resident. The complainant stated that he had reported concerns to a staff member about internal alterations to the upstairs toilet area being unsafe, prior to the accident and that no action had been taken. This was unresolved as details of the complaint had not been recorded by the home and the building work had progressed at the time of the investigation. The complainant was also of the opinion that the resident’s injury was a direct result of the area being unsafe. This was not upheld. Finally, the complainant reported that the resident had been unprepared for changes to toileting routines and toilet arrangements were inadequate. These matters were upheld. Five requirements were issued to the home to improve practice as a result of the findings. Policies and procedures were in place to ensure an appropriate response to suspicion or evidence of abuse. Staff spoken to had a basic awareness of the different types of abuse and their duty of care to protect residents. All staff had completed protection of vulnerable adults training.
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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 and 21 Many parts of the home were in need of repair / refurbishment, to ensure residents benefit from safe, comfortable surroundings. There were insufficient toilet facilities on the upstairs level, to meet the toileting needs of residents. EVIDENCE: Many parts of the home, in particular the furnishings in residents bedrooms, were in need of attention / refurbishment. The flooring to the hairdressing room had not been replaced, as required at the last inspection. Work had recently commenced on a major £750,000.00 building programme, to redevelop the environment, increase the bed capacity by a further six beds and to completely refurbish the home. As a result, two toilets had been taken out of use on the upstairs floor. On the day of the visit, there was only one toilet in operation upstairs, for twelve residents. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 13 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 and 30 There were insufficient domestic hours in place, to ensure the home was maintained in a clean and hygienic state. The home’s recruitment practice was satisfactory, to safeguard and protect the people living in the home. Some staff had not received the necessary training, to ensure competency in their role. EVIDENCE: Inspection of rotas and direct observation confirmed that three care staff were on duty at all times through the day and night. At the time of the visit, the home was in the process of recruiting two night staff and two weekend care assistants. Some residents and staff expressed concern that care staff also had to undertake cleaning duties, as the home had no domestic to clean the home. The laundry domestic was completing an additional one-hour per day and a member of staff worked an additional four hours on a Wednesday to clean the building. Three new staff had commenced employment at the home since the last inspection. Recruitment records were up-to-date and contained all the necessary information. Inspection of records and discussion with staff confirmed some staff had not completed all the mandatory training. This situation was also seen at the last inspection visit, when a requirement was made for action to be taken. A further three staff had completed a National Vocational Qualification at level 2 in Care. This brought the total number of qualified staff to six.
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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) 33, 38 Limited progress had been made on developing the home’s quality assurance system. Further work was needed to obtain and feedback the results and views of residents and other stakeholders. Some important records were not in place, to promote and protect the health, safety and welfare of service users. EVIDENCE: A corporate feedback form was used to obtain the views of residents and their representatives. Since the last inspection, a quality monitoring form had been developed and was due to be operational by the end of May 2005. None of the residents spoken with had attended a residents meeting. One resident reported “they don’t have residents meetings here, not that I know of” and another said “I have not been invited to any resident meetings.” Minutes of resident meetings were not available on the day of the visit. Service certificates were available for equipment within the home except for the fire alarm and emergency lighting system. A fire risk assessment could not be located and water temperature records were not being maintained. Records indicated that night staff were not receiving fire instruction training every three months. Policies and procedures were in place to promote Health and Safety.
Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 15 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 x 2 x x x x x STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x x x x 2 Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 16 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 (2) Requirement The assessment of service users needs must be kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Care plans must identify the health, personal and social care needs of service users and detail the action required by care staff to ensure that all the needs of service users are met. Furthermore, care plans must be reviewed on a monthly basis.. Unnecessary risks to the health and safety of service users must be identified and as far as possible eliminated. A record must be maintained for all complaints made by representatives or relatives of service users about the operation of the care home and the action taken by the Registered Person in respect of any such complaint.. The Registered Manager must ensure that the flooring to the hairdressing room is replaced. (Previous timescale of 1/02/05 not met. Timescale for action 27/05/05 2. 7 15 (1) & (2) 27/05/05 3. 8 13 (4) 27/05/05 4. 16 17 (2) 27/05/05 5. 19 23(2) (b) 27/06/05. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 17 6. 21 23 (J) 7. 27 18 (1) (a) 8. 30 18(1)(C) (i) 9. 10. 38 38 13 (4) 23 (4) (d) Sufficient numbers of toilet facilities must be provided within close proximity of service users private accommodation Domestic staff must be employed in sufficient numbers. to ensure that the home is maintained in a clean and hygienic state. The Registered Manager must ensure that all staff are updated in mandatory training areas and that training records are kept up to date. (Previous timescale of 1/03/05 not met). A Fire Risk Assessment must be completed. A maintenace service certificate must be obtained for the Fire Alarm System and a copy forwarded to the Commission. 27/05/05 27/06/05 27/07/05 27/05/05 27/05/05 11. 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. Refer to Standard 15 28 33 38 38 Good Practice Recommendations Service users should be provided with a choice of meals.. 50 of care staff should be trained to NVQ level 2 or equivalent. The registered person should ensure that feedback is sought from service users via individual and group discussion and minutes maintained.. Water temperature records should be maintained Night staff should receive fire instruction training every three months. Fazakerley House CS0000062027.V223388.R01.doc Version 1.30 Page 18 Commission for Social Care Inspection Burlington House, South Wing, 2nd Floor Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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