CARE HOMES FOR OLDER PEOPLE
Fazakerley House Residential Care Home Park Road Prescot Knowsley Merseyside L34 3IN Lead Inspector
Daniel Hamilton Unannounced Inspection 31st August 2006 09:30 X10015.doc Version 1.40 Page 1 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 Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 2 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 Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Fazakerley House Residential Care Home Address Park Road Prescot Knowsley Merseyside L34 3IN 0151 289 9203 Telephone number Fax number Email address Provider Web 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 Mrs Cathrine Joan Atkinson Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (30) Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The service may admit one named service user under pensionable age Date of last inspection 18th October 2005 Brief Description of the Service: Fazakerley House is a care home that is registered to provide personal care and support for up to 30 older people, including older people with a physical disability. It has recently been completely refurbished and modernised in order to improve the environment for the people living in the home. The home is located in the Prescot area of Liverpool and is easily accessible from the M57. Local shops, bank and public transport are situated approximately half a mile away. A smoking lounge and an air-conditioned conservatory is provided on the ground floor along with the office, kitchen area, dining room and a selection of bedrooms. The upper floor, which can be accessed by a passenger lift, comprises of the rest of the bedrooms. Fourteen of the rooms are equipped with en-suites and toilet and bathing facilities are located throughout. A call bell system is fitted in all areas of the home. Care Home Fees range from £327.46 to £350.00 per week. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted a total of 9.5 hours. 30 residents were living in the home at the time of 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, Senior Carer, two staff members, two relatives, a health care practitioner and six residents were spoken to during the visit. Furthermore, satisfaction survey forms “Have Your Say About….” were distributed to a number of residents and / or their relatives prior to the inspection, to obtain additional views / feedback about the home. All the core standards were reviewed and previous requirements and recommendations from the last inspection in October 2005 were discussed. What the service does well:
Fazakerley House presented as warm and caring environment. Since the last visit, the environment had been completely redecorated and refurbished in order to provide the residents with an accessible, safe and well maintained home. One resident stated; “It’s like living in luxury” and another reported; “It’s a lovely home and very comfortable.” All areas viewed were clean and fresh. Staff were observed to be attentive and respectful towards the individual needs of residents and residents complimented the service provided. Comments included; “All the carers are courteous and caring in their approach” and “The staff are always willing to listen and help.” Staff were observed to be attentive to the needs of residents and spent time talking to residents and offering individual support throughout the day. The home had developed a Statement of Purpose, Service User Guide and Contract to provide information to prospective residents and / or their representatives on the service provided and their rights and responsibilities. Assessments had been undertaken to identify the needs of residents and care plans had been completed to ensure staff were aware of the support they needed to provide residents. Care plans had been kept under regular review. Residents confirmed that they had control of their lives and were generally satisfied with the lifestyle experienced in the home. For example, a resident said; My son and daughter can visit me when they want and I am able to leave the home and visit my friends independently.” Another resident said; “There Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 6 are no restrictions . I’m quite amazed and very satisfied with the care provided.” A three-week rolling menu had been developed which detailed that a range of nutritious and wholesome meals were provided. Feedback received from residents confirmed the people living in the home were generally satisfied with the meals. Comments included; “I very much enjoy the meals. They are wellcooked and nicely presented” and “The food is nice and there are alternatives available.” A ‘Complaints Procedure’ was in place and feedback received from residents confirmed that they were aware of whom to talk to if they had a concern and that they felt listened to. Complaints received by the home had been responded to promptly. Systems were in place to protect the people living in the home from abuse, to safeguard health and safety and to monitor and review the standard of care provided in the home. What has improved since the last inspection? What they could do better: Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 7 Pre-admission assessments completed by the home had not been dated. Assessments should be dated to confirm they have been completed before residents move in and to provide evidence that they are kept under review. The home had experienced difficulties in supporting some residents to access chiropody services under the National Health Service. The home should continue to monitor this issue and ensure residents have access to health care services, subject to need. Medication entering the home had not always been booked in and there was no record of staff checking the quantity of medication entering the home on a weekly basis. This practice is not safe and must stop. The people living in the home had been consulted about the activities and meals provided however some residents remained concerned about the options available. A resident reported; “I think there could be more to do for those that can do them. For example there could be armchair exercises or day trips.” Another resident stated; “I feel the evening meal needs to be more varied.” The home should keep these matters under review in consultation with residents. Although the home had made good progress in providing training to staff, training records and discussion with staff confirmed that some new staff had completed; induction, fire safety, basic food hygiene, moving and handling, health and safety and protection of vulnerable adults training in one day. It is recommended that more time is set aside when training staff in a range of topics. Furthermore, the manager should make arrangements to undertake a National Vocational Qualification at level 4 in Care or equivalent. Written records were available for money handled on behalf of residents but receipts had not been obtained for all expenditure. Receipts must be obtained for all money handled, to protect the interests of all the residents and the registered provider. In order to safeguard health and safety, all sections of the home’s risk assessment manual should completed. 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 Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents had access to a range of information on the home to enable them to make an informed decision about the service provided. Assessments had been completed, to ensure the needs of residents were identified. EVIDENCE: The home had developed a Statement of Purpose and Service User Guide to provide information to prospective residents on the service provided and their rights and responsibilities. Residents confirmed via Care Home Surveys and through discussion that they had received information about the home which enabled them to make an informed choice about the suitability of the home and where to live. Contracts had also been produced and signed copies were available on files viewed. Three files were examined during the visit for residents who had moved into the home since the last inspection. Each file contained a copy of an assessment completed by a social worker.
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 10 Only two of the three files viewed contained a ‘Pre-Admission Assessment’ that had been completed by the home. It was not possible to determine when the assessments had been undertaken, as the assessments had not been dated. The home’s assessment documentation enabled a comprehensive assessment of needs to be undertaken. Advice was given on how the assessment could be further improved in order to respond to the diverse needs of individuals accessing social care services. The senior member of staff on duty confirmed that information gained from the assessment process was used to develop a plan of care for each resident. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were in place that detailed residents’ individual needs and the support required to meet them. Some medication administration records were not being appropriately maintained, to account for medication received. Residents generally had access to a range of health care services subject to individual needs, however some difficulties had been experienced in accessing chiropody services. Care was provided in a manner that satisfied the needs and expectations of residents. EVIDENCE: Three files were viewed for residents who had recently moved into the care home. Each file contained a plan of care that detailed the individual needs of residents, the level of support required by staff and goals / objectives. Care plans had been signed by residents or their representatives and a system had been established to ensure each plan was kept under monthly review. Staff spoken with during the visit demonstrated a good understanding of the needs of residents and the importance of referring to care plans for information. A range of supporting documentation had also been developed. This included: risk assessments to address person centred, environmental and handling and
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 12 mobility risks. Furthermore, details of personal property, last wishes, medication declaration / consent forms, continence assessments, daily report sheets, record of activities and monthly weight records were available on files viewed. Overall, feedback received from residents and / or their representatives via care home survey forms or through discussion confirmed residents had access to health care professionals as required. Comments from residents included; “The doctor is called when required” and “The staff look after out health care needs and arrange appointments as necessary”. Records of chiropodist, district nurse, doctors and hospital appointments were available on some files seen Some Care Home Survey forms received highlighted concern about the availability of chiropody services under the National Health Service. Some medical intervention records viewed had no details of chiropody appointments and the senior member of staff on duty confirmed the home had experienced difficulties accessing this service. Health care records highlighted that some residents had not seen chiropodists for several months. The home had a copy of the Provider’s corporate medication policy. Local medication handling procedures had also been produced by the manager for staff to reference. At the time of the visit six residents were self-administering medication and risk assessments had been completed to safeguard the health and safety of residents. A record of staff authorised to administer medication together with sample signatures and a system to check the identity of residents prior to administering medication was in place. Examination of training certificates verified that staff designated with responsibility for administering medication had completed the ASET safe handling of medicines training. Medication was stored in a locked air-conditioned room within a medication trolley. A fridge was available to store medication requiring cold storage and a daily record of temperature was maintained. Suitable storage was in place to store controlled drugs and appropriate records were maintained. Since the last visit, the home had changed pharmacists and had introduced a new medication system, which was delivered on a weekly basis. Records were checked for three service users. Medication Administration Records showed that some medication received into the home had not always been booked in. For example there was no record of Lansoprazole 30m/g being booked in on 21/08/06. Likewise, there was no record of staff checking the quantity of medication entering the home on a weekly basis. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 13 Staff spoken with during the visit demonstrated a good understanding of how to promote the social care values of respect and privacy in their day-to-day practice. Staff were observed to be patient, respectful and sensitive to the needs of residents during the visit. Feedback received from residents via Care Home Survey forms and via discussion confirmed they were treated with respect and privacy and were satisfied with the standard of care provided. Comments included; “The staff are always willing to listen and help”; “The majority of staff will not enter my room without knocking and asking if they can come in” and “All the carers are courteous and caring in their approach.” Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents remained in control of their daily lives in order to maintain their independence, relationships and preferred lifestyles. A programme of activities had been developed. This did not satisfy the recreational interests of some residents. Residents received wholesome, balanced and appetising meals. Some residents felt the alternative meal options remained limited. EVIDENCE: A programme of activities had been developed since the last inspection in consultation with residents. The activities on the programme included; hairdressing, religious services, dominoes, cards, sing-a-longs, manicures, choice of games, reminiscence, ‘old time music’ and shopping trips. Entertainers were booked for special occasions. Individual activity sheets were used to record the details of activities that residents had chosen to participate in. Records viewed reflected different levels of participation / interest in a limited range of activities and feedback from residents via care home surveys and through discussion highlighted different expectations, views and satisfaction levels regarding the provision of activities. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 15 Some residents said they were satisfied with the activities provided and others reported that they preferred not to participate or would welcome further change. Comments included: “Please can we have more variety”; “Activities are limited”; “I think there could be more to do for those that can do them. For example there could be armchair exercises or day trips.” Residents spoken with confirmed that they were able to receive visitors at any reasonable time and were observed to be meeting friends and relatives during the visit. The visitors book in reception detailed that visitors called at different times of the day. One resident spoken with said; My son and daughter can visit me when they want and I am able to leave the home and visit my friends independently.” Likewise, a visitor reported; “There are no set visiting times. I am always made to feel welcome.” Policies and procedures were in place that promoted the rights of service users to maintain their independence. Staff spoken with demonstrated an awareness of the importance of empowering residents to have control of their life and the need to balance rights, risks and responsibilities. The routines in the home appeared to be flexible and overall, residents spoken with confirmed that they had control of their lives and were able to follow their preferred routines and lifestyle. Feedback from residents included; “I can stay up and go to bed whenever I want” and “There are no restrictions. I’m quite amazed and very satisfied with the care provided.” Rooms viewed had been personalised and residents confirmed that they were aware of their right to access their personal files. A three-week rolling menu had been developed. Minutes of residents meetings confirmed that residents had been consulted about the meals provided and that the home was planning to introduce a four-week menu in the near future. Menus viewed confirmed that the home provided a range of nutritious and wholesome meals. A set alternative was available for lunch-time. This was soup and a roll and jacket potatoes with various fillings or Salads (summer months only). The alternative for the teatime meal was assorted sandwiches. Feedback from residents via care home surveys and discussion confirmed the people living in the home were generally satisfied with the meals provided. Comments included; “The food is nice and there are alternative choices” and “I very much enjoy the meals. They are well-cooked and nicely presented.” Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 16 Some residents and their representatives expressed concerns regarding the choices on offer, especially the set alternative of sandwiches for tea. Comments included; “I feel the evening meal needs to be more varied” and “The meals would benefit from more variation.” Meals were served in the home’s dining room at set times, however arrangements were flexible to accommodate individual needs. Additional drinks were served throughout the day and residents spoken with confirmed that they were able to eat their meals in their room if they wished. The dining room had been refurbished and equipped with new dining tables and chairs since the last visit. Care staff were observed to be available to provide assistance to residents who required support at mealtimes. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents confirmed that they felt listened to and that their views were acted upon. Safeguards were in place to protect the people living in the home from abuse. EVIDENCE: Fazakerley House had a Complaints Procedure in place that detailed that complaints would be responded to within 21 working days. A copy of the procedure was available in the Statement of Purpose / Service User Guide and displayed in the reception area. The home maintained a record of all concerns / complaints. This showed that seven complaints / concerns had been received by the home since the last visit. Records provided evidence that all complaints had been acted upon promptly by the manager and detailed the name of each complainant, the nature of each complaint and the action taken by the manager. The nature of complaints / concerns received included; the temperature of drinks; missing clothing; the choice of meals on the menu and issues of concern between residents. No complaints, concerns or allegations had been received by the Commission for Social Care inspection since the last visit in October 2005. Feedback received from residents via Care Home Surveys and through discussion confirmed that the people living in the home knew who to speak to if they were not happy and how to make a complaint. Likewise, residents
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 18 reported that they felt listened to by staff and that they acted upon their comments. Comments included; “There’s always a senior care worker or the home manager to talk to”; “Staff try their best to help” and “I have no complaints. It’s a good place to be.” The home had a range of policies and procedures in place to ensure an appropriate response to suspicion or evidence of abuse. Training records showed that staff had completed training in the ‘Protection of Vulnerable Adults’ and staff spoken with during the visit were able to demonstrate a good understanding of the different types of abuse, reporting procedures and their duty of care to safeguard vulnerable adults. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment was suitable for the needs of the residents and was accessible, well maintained and clean. EVIDENCE: Since the last visit all parts of the home, had been modernised and completely refurbished and redecorated. This included the replacement of all furniture and fittings. Some internal parts of the home had been altered in order to create six new bedrooms with en-suites. A climate controlled conservatory had been built to provide additional communal space for residents to use. The home was accessible to residents. A new passenger lift had been installed which was compliant with disability discrimination act guidelines and a call bell system was fitted throughout the home. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 20 Handrails were fitted along corridors and hoisting equipment was in place. Service users had personal mobility aids and grab rails were fitted in each room / ensuite, subject to individual needs. Residents spoken with were very impressed with the quality of the environment. Comments included; “I could not imagine a nicer place to live”; “It’s a lovely home and very comfortable” and “It’s like living in luxury.” The home employed a part-time handyperson and three part-time domestics. Areas viewed were well maintained, clean and hygienic. The laundry was sited away from food preparation areas and was suitably equipped with two washing machines (with a sluice facility), a dryer and individual baskets to store each resident’s items of clothing. Sluicing facilities were available on each floor. Control of Substances Hazardous to Health (COSHH) data sheets and infection control policies were in place. Training records showed that staff had received training in basic food safety and hygiene. Feedback from residents confirmed the home was kept clean and fresh at all times. Comments included; “A1 cleanliness. It couldn’t be better”; “The place is kept spotless” and “The physical environment is excellent. There is no smell. The staff are very aware of cleanliness.” Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 21 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff were deployed to meet the needs of the people living in the home. Recruitment practice was robust and this safeguarded the welfare of residents. Good progress had been made in providing staff with the necessary training to ensure competency and safe working practices. EVIDENCE: The Senior Carer on duty reported that the staffing levels had increased since the last visit, as the number of residents living in the home had increased from 24 to 30. Examination of rotas, direct observation and discussion with staff and residents confirmed that three care staff and a senior carer were on duty through the day from 8.00 am to 8.00 pm. Three care staff (including a senior) remained on duty at night. The manager worked Monday to Friday each week. Residents generally spoke highly of the staff and confirmed that staff were available when needed. Comments include; “Excellent care and support”; “The carers are very attentive” and “Staff are generally friendly and helpful.” A relative reported; “All the carers who help my father are compassionate, caring, friendly, willing and kind.” One anonymous care home survey form received detailed that the home was not always able to provide staff to accompany residents to hospital appointments and delays of up to 10 minutes before a staff member opened
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 22 the front door to the home. These points could not be substantiated during the visit. The home had a corporate recruitment and equal opportunities policy in place. Records showed that four care staff had started since the last visit. All four personnel files were viewed. Recruitment records showed that each member of staff had commenced employment following the receipt of Protection of Vulnerable Adult / Criminal Record Bureau check and two satisfactory references. Other records required under the Care Home Regulations were in place. These included proof of identity, health declarations, supervision and training records. Records showed that the home employed 20 care staff. Training records / certificates viewed confirmed that 4 staff had completed a National Vocational Qualification (NVQ) in Care at level 2 or above (20 ). The senior carer reported that a further 5 staff had completed the training and were awaiting certificates (25 ). An additional 2 staff (10 ) were working towards the award. Once the remaining staff have completed the training, 55 of the staff will attained the qualification. The home had an induction programme in place that was linked to National Training Organisation Standards. Examination of training records and discussion with staff confirmed that staff had received induction and additional training that was relevant to their role. The training record and certificates for a new member of staff indicated that induction, fire safety awareness, basic food hygiene, moving and handling, health and safety and protection of vulnerable adults training had been completed in one day. The home was advised to allocate more time for training, to enable staff to reflect upon learning experiences. The home’s training matrix showed that progress had been made in providing training for staff in a range of Safe Working Practice topics since the last visit. A senior member of staff had completed a moving and handling instructors certificate and was qualified to train staff in moving and handling techniques. Likewise, the manager had completed ‘Fire Marshall’ training during February 2006 and had provided Fire Training to staff. Pre-inspection records detailed that training in ‘Palliative Care’, ‘Dementia’ and ‘Nutrition in the Elderly’ was also in the process of being planned for staff. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 23 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives were consulted about the service periodically, to ensure their views were obtained and acted upon. Receipts had not always been obtained, to account for money handled on behalf of residents. Overall, systems were in place to safeguard health and safety however some risk assessment / management plans had not been completed for all safe working practice topics. EVIDENCE: The Registered Manager of the home (Mrs Catherine Atkinson) was registered with the Commission for Social Care Inspection and had managed the home for a number of years. Training records showed that the manager had completed the National Vocational Qualification (NVQ) level 4 in management, the D32/D33 care assessors award and a range of safe working practice and additional training that was relevant to her role. No training record or certificate could be found to confirm that the manager had completed a NVQ level 4 in Care or equivalent.
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 24 Residents and staff spoken with confirmed the manager was supportive and committed to developing the home in the interests of the people using the service. The Operations Manager had undertaken regular visits on behalf of the provider and produced a monthly report in accordance with Regulation 26. Four ‘Residents Meetings’ had been coordinated since the last visit and brief minutes were available which showed that discussion had taken place regarding the home’s menus, activities, quality of care and refurbishment. A Residents / Representatives survey had been completed during July 2006. This involved distributing 30 questionnaires to residents or their representatives to seek their views on a range of issues. Sections of the survey included: the management of the care centre; the helpfulness of staff; cleanliness and décor; activities and events; food, menus and service and the company’s brochures and newsletters. 21 (70 ) of the thirty questionnaires were completed and returned. The outcome of the survey indicated that satisfaction levels were consistently high across all sections of the survey, with the majority of the results falling in a range between ninety to one hundred per cent. Social activities and events were rated slightly below the average level at seventy seven per cent as noted in standard 12. The home had a policy on ‘Residents Finances.’ Pre-inspection records showed that the manager did not act as an appointee for any of the residents and that all the residents received support from either family members or solicitors to manage their finances. The Organisation’s head office was responsible for invoicing residents or their representatives for fees and a system was in place to enable payments to be made by standing order. The Senior Carer on duty reported that the home looked after the personal finances of twenty-four residents. Records were checked for three residents. All transactions had been recorded and balances were correct. Receipts were not available for some expenditure. A ‘Health and Safety Policy’ was in place. Training records and discussion with staff confirmed that the majority of staff had completed training in Health and Safety. Pre-inspection records detailed that maintenance and associated records were in place for all key areas.
Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 25 Examination of fire records showed that the fire officer had visited during May 2006 and that the fire alarm system was tested on a weekly basis. Monthly checks on the fire extinguishers and emergency lighting had also been undertaken. Staff had received annual Fire Awareness training and day and night staff had received fire instruction refresher training at appropriate intervals throughout the year. All the hot water outlets were fitted with thermostatic water valves to minimise the risk of scalding and the handyman had completed monthly checks of the temperature at each outlet. Risk assessments had been completed to prevent slips, trips and falls, the spread of legionella and fire. The home’s ‘Catering’, ‘General Cleaning’ and ‘Care Practice’ risk assessment had not been completed. Since the last visit, the home had obtained a service certificate for gas safety and the new passenger lift. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13(2) Requirement All medication entering the home must be checked, signed in and dated on the medication administration record. [Previous timescale of 18/11/05 not met]. Receipts must be obtained for all money handled on behalf of residents. Timescale for action 31/10/06 2 OP35 17 (2) Schedule 4 31/10/06 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 OP3 OP7 OP12 OP15 OP30 Good Practice Recommendations Pre-admission Assessments should be dated to confirm they have been completed prior to residents moving into the home. Residents should have regular access to Chiropody services, subject to individual need. The activities programme should be kept under review in consultation with residents. The alternative choice of meals should be kept under review in consultation with residents. More time should be allocated for staff induction training
DS0000062027.V295734.R01.S.doc Version 5.2 Page 28 Fazakerley House Residential Care Home 6 7 OP31 OP38 when covering a range of subjects e.g. induction, fire safety awareness, basic food hygiene, moving and handling, health and safety and protection of vulnerable adults. The manager should complete a National Vocational Qualification level 4 in Care or equivalent. The home’s ‘Catering’, ‘General Cleaning’ and ‘Care Practice’ risk assessment should be completed. Fazakerley House Residential Care Home DS0000062027.V295734.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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