Inspection on 23/08/04 for Field Farm House

Care Home For Older PeopleField Farm HouseHampton Bishop Herefordshire HR1 4JPUnannounced Inspection23rd August 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. Field Farm House ­ 23rd August 2004ESTABLISHMENT INFORMATION Name of establishment Field Farm House Address Field Farm House, Hampton Bishop, Herefordshire, HR1 4JP Email address Name of registered provider(s)/company (if applicable) Advent Estates Ltd Name of registered manager (if applicable) Ms Jane Barrington Type of registration Care Home No. of places registered (if applicable) 27 Tel No: 01432 273064 Fax No:Category(ies) of registration, with (number of places) Dementia - over 65 years of age (27), Mental Disorder, excluding learning disability or dementia - over 65 years of age (27), Old age, not falling within any other category (27), Physical disability over 65 years of age (27) Registration number E020000207 Date first registered Date of latest registration certificate 15th January 2004 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspection 15th January 2004 YES YES 01.03.04 If Yes refer to Part CField Farm HousePage 1 Field Farm House ­ 23rd August 2004Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 323rd August 2004 09:00 am Philippa JarvisID Code075901Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionMrs T W Chew.Field Farm HousePage 2 Field Farm House ­ 23rd August 2004CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementField Farm HousePage 3 Field Farm House ­ 23rd August 2004INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Field Farm House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Field Farm HousePage 4 Field Farm House ­ 23rd August 2004BRIEF DESCRIPTION OF THE SERVICES PROVIDED. The Home is registered to accommodate service users aged over 65years. Their care needs arise as a result of the ageing process, because of a physical disability or because of a mental disorder including a dementia illness. The Home does not set out to provide for the needs of highly dependent people. Field Farm House is a converted farmhouse with an extension, set in large grounds, just outside the city of Hereford. The home is rurally based and all facilities are in Hereford city. The accommodation is on two floors and there is a passenger lift to provide access. There are 24 bedrooms. 21 are solely for single use and 3 may be for shared occupancy. Some have en-suite facilities. There are 2 lounges and a separate dining room. There are level gardens to the front of the home where service users can sit or walk around.Field Farm HousePage 5 Field Farm House ­ 23rd August 2004PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection took place one day time in August 2004. New providers took over the home in December 2003 and there was evidence that they are continuing to work towards ensuring that the National Minimum Standards are met. There remain a number of areas that need attention and consequently are reflected in the requirements. The experience of the people living in Field Farm House is that receive a good quality of care from a caring and committed staff group. Those spoken with expressed their satisfaction with the care they were receiving. The atmosphere in the home was friendly and relaxed. Choice of Home (Standards 1-6) 1 standard was assessed and met. The quality of documentation available to inform service users about Field Farm House is good. There had been a careful assessment of a prospective service users need before admission to ensure that this person would be suitably placed. Health and personal care (Standards 7-11) 3 standards were assessed, 2 were met and 1 almost met. The care planning process has continued to develop but still needs further consolidation. There was evidence the appropriate attention was paid to ensuring that the health care needs of the service users were met. Service users expressed the view that their privacy and dignity were well respected and they were confident that their health care needs were met appropriately. Daily Life and Social Activities (Standards 12-15) 2 standards were assessed, 1 was met, 1 was not met. Service users were able to choose their daily routines and an activities coordinator is employed 3 sessions a week. The registered persons need to review the provision of food in the home to ensure that a balanced diet is provided. Complaints and Protection (Standards 16-18) 1 standard was assessed and almost met. The manager has a good awareness of Adult Protection Procedures and staff now need to receive training in this area. Environment (Standards 19-26) 3 standards were assessed, 2 were met and 1 was almost met. Field Farm House provides suitable accommodation for the service user group. The premises were not fully inspected on this occasion but the inspector was informed that the providers are continuing to make improvements to the building. At the time of the inspection, the laundry was in the process of being upgraded. There were suitable infection control Field Farm House Page 6 Field Farm House ­ 23rd August 2004procedures in place. Staffing (Standards 27-30) 2 standards were assessed, 1 was almost met and 1 was not met. The staffing levels on duty at the time of the inspection were as detailed on the rota an as agreed with the registration authority. The care staffing levels need to be kept under review. A member of staff had recently been recruited and the procedures used were not to a satisfactory standard. This places the service users at risk. Management and Administration (Standards 31-38) 2 standards were assessed, 1 was met and 1 was not met. Staff and service users reported that the manager was approachable and that they were informed of issues in relation to the home the inspector was aware that there were certain aspects of the management of Field Farm House that had not been carried out to the required standard and would recommend that the management structure of the home is reviewed to ensure sufficient management time is available to carry out the full range of tasks involved. There were aspects of practice relating to fire safety that needed to be addressed to ensure the safety of the service users.Field Farm HousePage 7 Field Farm House ­ 23rd August 2004Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action These requirements were identified during this inspection. A record must be set up which details all monies handled on behalf of the service 7 17 OP18 Immediate users. This must constitute a full audit trail. Not inspected ­ carried forward. The laundry floor must be replaced with an 30th impermeable floor covering and the wall 8 13 OP26 September finishes made readily cleanable. 2004. Timescale has not expired. A staff training and development programme 31st July 10 18 OP30 must be set up and implemented. 2004 Not inspected ­ carried forward. The Provider must develop a system to 30th monitor and audit the quality of service 11 24 OP33 September delivered by the home. 2004. Timescale has not expired. The Manager must ensure that care staff receive formal supervision at least 6 times a 31st July 12 18 OP36 year. 2004. Not inspected ­ carried forward. All staff must receive suitable work based 30th June 14 23 OP38 training in fire prevention to include fire drills 2004. and fire safety. Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements.Field Farm HousePage 8 Field Farm House ­ 23rd August 2004RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard These recommendations were identified during this inspection. 5 OP28 Consideration should be given to how the home will meet the target of 50 staff trained to NVQ 2 by April 2005. Not inspected ­ carried forward.CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)Field Farm HousePage 9 Field Farm House ­ 23rd August 2004STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action These requirements were identified at the last inspection. They were not inspected on this occasion and are therefore carried forward. 1 17 OP18 A record must be set up which details all monies handled on behalf of the service users. This must constitute a full audit trail. The laundry floor must be replaced with an impermeable floor covering and the wall finishes made readily cleanable. A staff training and development programme must be set up and implemented. The Provider must develop a system to monitor and audit the quality of service delivered by the home. The Manager must ensure that care staff receive formal supervision at least 6 times a year. All staff must receive suitable work based training in fire prevention to include fire drills and fire safety. These requirements were identified during this inspection. Field Farm House Page 10 Ongoing 30th September 2004. 31st July 2004. 30th September 2004. 31st July 2004. 31st October 2004.213OP26318OP30424OP33518OP36623OP38 Field Farm House ­ 23rd August 20047OP16OP15The provision of food for service users must 31st be reviewed to ensure that a suitable and well October balanced diet is provided. 2004. A record of food provided must be kept in the home. This must detail the alternatives provided for service users. Immediate.817OP37913OP1831st All staff must receive training in the Protection December of Vulnerable Adults. 2004. Thorough recruitment procedures must be used at all times to ensure the protection of the service users. Immediate and ongoing.1019OP291113OP38Checks must be carried out on a monthly basis to all fire doors to ensure that they close Immediate. into their rebate.RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * This recommendation was identified at the last inspection. It was not inspected on this occasion and is therefore carried forward. 1 OP28 Consideration should be given to how the home will meet the target of 50 staff trained to NVQ 2 by April 2005. These recommendations were identified during this inspection. 2 OP7 The care planning process should continue to develop to ensure that each service user has a current plan of care that is reviewed on a monthly basis. The care staffing levels should be kept under review to ensure that the assessed needs of the service users can be met at all times.3OP27* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Field Farm HousePage 11 Field Farm House ­ 23rd August 2004PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) Field Farm House YES YES NO YES YES YES NO NO NO NO YES NO YES YES NO NO NO NO NO YES 5 0 0 YES YES YES YES X 0 23/08/04 10.00 5.30 Page 12 Field Farm House ­ 23rd August 2004The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Field Farm HousePage 13 Field Farm House ­ 23rd August 2004Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) X To (£) XAny charges for extrasYES 0If yes, please state what the extras are: Key findings/Evidence Standard met? Not inspected. This standard was assessed at the last inspection and was met.Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 0 Key findings/Evidence Standard met? Not inspected. It was noted that a signed statement of terms and conditions of residence was maintained in the file of a newly admitted service user.Field Farm HousePage 14 Field Farm House ­ 23rd August 2004Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? The inspector sampled the file of one recently admitted service user. There was an assessment undertaken prior to admission that addressed the areas detailed in the standard. This was signed and dated by the assessor and by the service user. There was a personal preferences and daily routines form completed within two days of admission. This contained a good amount of useful detail and had been signed by the service user. This information had led to a plan of care for daily living. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? Not inspected.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met. Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? Intermediate care is not provided.Field Farm HousePage 15 Field Farm House ­ 23rd August 2004Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 2 Key findings/Evidence Standard met? It was reported that the manager is continuing to update care plans and the inspector was shown one that was to an appropriate standard. Two of those seen by the inspector continued to need attention to bring them to a fully satisfactory standard but there was evidence that they had continued to develop since the last inspection. It was pleasing to see that a short-term plan had been written for staff use when a service user was poorly. There was also evidence that risk assessments had been undertaken for falls, manual handling and pressure area care. Care needs to be taken to ensure that these documents are dated and signed by the author. Whilst some plans had been reviewed, further attention needs to be paid to ensure that this is done on a monthly basis. See recommendation. The home has adopted a system whereby they keep a fully detailed plan in the office with a working summary in each service users room for staff and interested parties to refer to as required.Field Farm HousePage 16 Field Farm House ­ 23rd August 2004Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) X 13 Key findings/Evidence Standard met? The inspector was informed that one service user had a pressure sore and that the home was receiving regular support from the district nurse in its management. The home has recently purchased 6 specialist mattresses and 6 pressure-relieving cushions for the promotion of skin integrity. There was evidence of assessment of skin care needs in service users files. The activities coordinator works for 4 sessions a week and part of her role is to encourage physical activity. She reported that she hopes to be able to undertake a specialised course in physical activity for older people in due course. There are scales available in Field Farm House and service users are weighed on a regular basis. The plans of are would benefit from further development of information about nutritional assessment. There was evidence on service users files of recording about contact with GPs. There was also evidence about contact with other health care professionals. Service users confirmed that they were confident that their health care needs were well addressed. Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 0 Key findings/Evidence Standard Met? Not inspected on this occasion. At the last announced inspection a specialist pharmacy inspector reviewed the medication practices in Field Farm House. The standard was almost met on that occasion and the provider reported that all requirements and recommendations had since been implemented.Field Farm HousePage 17 Field Farm House ­ 23rd August 2004Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? Those spoken with said that their personal care was always given in private and they were able to see health care professional and relatives in their own room. Staff always knocked at their door. Their own clothes were returned to them from the laundry. Staff spoken with confirmed that this aspect of practice is emphasised.Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? Not inspected.Field Farm HousePage 18 Field Farm House ­ 23rd August 2004Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 3 Key findings/Evidence Standard met? Those service users spoken with confirmed that they were able to exercise as much choice as they wished over their daily routines. There was limited information about service users interests in their care plans. There is an activities coordinator who works in the home for 3 sessions a week (on the 4th day she works a s a hairdresser). She reported that she spends a little time with each service user at the beginning of the week to discuss their requirements and tries to ensure that there is some time for 1 to 1 sessions as well as group activities. Information about activities may be listed on the notice board. There were a number of large print books available in the hall. Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met.Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met.Field Farm HousePage 19 Field Farm House ­ 23rd August 2004Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 1 Key findings/Evidence Standard met? The inspector spoke with the cook for the day and service users about the provision of food in the home as well as looking at records, around the kitchen and observing the meal provided for lunch. Service users have three full meals a day and drinks and snacks are provided in between if required. There is a kitchenette area attached to the dining room where drinks are available for service users and their visitors. There is a 4-week rolling menu. There was some repetition within this. An alternative was not routinely provided. Details of the daily meals are displayed on each table in the dining room. Service users can choose from a good range of choices at breakfast. Lunch on the day of inspection comprised cheese and potato flan, boiled potatoes and peas followed by bread and butter pudding. The view of the inspector was that there was too much carbohydrate within this meal. The kitchen was well stocked with food provisions and there was fruit available in the lounge for service users to help themselves to. There was no record kept of alternatives to the main meal although the cook reported that service users could always have something different if they requested. The cook was aware of the needs of service users with special dietary requirements. The mealtime was observed to be unhurried and staff were available to assist if required. See requirement.Field Farm HousePage 20 Field Farm House ­ 23rd August 2004Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days X X X X X X X 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met. Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met.Field Farm HousePage 21 Field Farm House ­ 23rd August 2004Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES 02 Key findings/Evidence Standard met? The home has an Adult Protection Policy. A member of staff spoken with was aware of this policy but had not read it nor had she received training with regard to Ault Protection. See requirement. The manager has previously shown that she is aware of appropriate action to take in the event of suspected abuse. The home currently holds the pension book for a small number of service users. At the time of the inspection it was reported that no money or valuables were stored on behalf of any service users.Field Farm HousePage 22 Field Farm House ­ 23rd August 2004EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? Field Farm House is located just outside the city of Hereford in a rural location. The home is on 2 floors and there is access via a shaft lift. The grounds were tidy and areas of these were accessible to service users, and they were in the process of being developed so that they were more interesting for the service users. A gardener/handyman has been employed to undertake routine maintenance and upkeep of the gardens. The provider has a plan for upgrading the home and for ensuring that routine maintenance and renewal of the fabric and decoration is carried out. The practice of leaving the front door unlocked has ceased: this makes the environment safer for those service users with a tendency to wander. A side door is unlocked for easy access for those who need it. The office is situated at the rear of the building, and has been extended and upgraded to provide a more suitable environment. The inspector did not tour the premises during this visit, although some areas were seen. There has been some replacement of carpets in the corridors and the provider stated their intention of continuing this process. It was noted that in one area worn carpet had been jointed with tape. The safety of this arrangement must be assessed to ensure that it does not create a tripping hazard.Field Farm HousePage 23 Field Farm House ­ 23rd August 2004Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met. Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 0 Key findings/Evidence Standard met? Not inspected.Field Farm HousePage 24 Field Farm House ­ 23rd August 2004Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite NO YES NO 21 9 3 0 3 21 01 0 3 0Key findings/Evidence Standard met? At the time of the inspection no rooms were being used on a shared basis.Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 0 Key findings/Evidence Standard met? Not inspected. Field Farm House Page 25 Field Farm House ­ 23rd August 2004Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 0 Key findings/Evidence Standard met? Not inspected.Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 2 Key findings/Evidence Standard met? The laundry facilities were in the process of being upgraded at the time of the inspection. Plans were in hand to complete this work. The home has obtained a suitable Infection Control Policy. Some staff had completed infection control training and it was reported that 8 further staff were enrolled to commence training in this area.Field Farm HousePage 26 Field Farm House ­ 23rd August 2004StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours X X 0 needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X 0 0 00 X X Standard met? 2Field Farm HousePage 27 Field Farm House ­ 23rd August 2004There was a staff rota available for the week of the inspection. This indicated that there were 3 care staff on duty throughout the waking day, one of whom was designated at a senior level, and that there was one waking senior carer on active duty overnight with a second carer asleep on the premises and available in the event of need. There were no additional staff on duty at busy times of the day. The management and activity organiser hours were not detailed on the rota and they were in addition to the care hours. The care staffing levels are limited for 24 service users. If dependency increases or there are any further admissions, consideration must be given to increasing the care staffing hours. See recommendation. At the time of the inspection the care staff arrangements were as indicated on the rota. In addition to the 3 care staff, there was a cook, a cleaner, an activities organiser and one of the providers on the premises. The cook is on duty 6 hours a day. Care staff assist with the preparation of breakfast and tea/supper which is served from the kitchenette in the dining room. There were domestic staff in addition and those areas of the home that were seen were clean, tidy and odour free. Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence Not inspected. X X Standard met? 0Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 1 Key findings/Evidence Standard met? The inspector looked at the file of a newly recruited member of staff. There was an application form that had not been fully completed, and 2 written references had been received. CRB and Protection of Vulnerable Adults checks had not been carried out and the member of staff had not provided proof of identity. These recruitment procedures do not meet the expected standard and consequently place the service users at risk. See requirement.Field Farm HousePage 28 Field Farm House ­ 23rd August 2004Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 0 Key findings/Evidence Standard met? Not inspected.Field Farm HousePage 29 Field Farm House ­ 23rd August 2004Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 0 Key findings/Evidence Standard met? Not inspected. Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? Staff and service users were of the view that there was an open approach to the management of the home. They reported that they could approach the manager or the provider with any views, queries or concerns. There have been staff meetings (minuted). There was a notice on a display board about a forthcoming residents meeting. Staff confirmed that they are encouraged to read policies and procedures and records. Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 0 Key findings/Evidence Standard met? Not inspected.Field Farm HousePage 30 Field Farm House ­ 23rd August 2004Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? Not inspected. Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence Not inspected. Standard met? 0 X X XStandard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 0 Key findings/Evidence Standard met? Not inspected. Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 0 Key findings/Evidence Standard met? Not inspected. This standard was assessed during the last inspection and was met.Field Farm HousePage 31 Field Farm House ­ 23rd August 2004Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? There has been continued attention to providing care staff with training related to health and safety matters. Most staff have received training in moving and handling during the last 8 months. Some staff have received training in fire safety but not all. There was no record of fire drills having taken place although the provider reported that they had occurred. The inspector noted that some doors did not close into their rebate and thereby caused a fire safety hazard. See requirement. It was reported that a health and safety policy had been drawn up for the home by an outside consultancy. There was a bathing policy in place for service users. Accidents were recorded appropriately in the accident book. It was noted that one of these needed to be reported under RIDDOR and the provider did so during the course of the inspection.Field Farm HousePage 32 Field Farm House ­ 23rd August 2004PART C(where applicable)COMPLIANCE WITH CONDITIONSNO Condition Compliance 1. Ms Jane Barrington must complete the Registered Managers Award by April 2005. 2. Ms Jane Barrington must complete strategic level fire safety training by 1st August 2004 Comments The timescale has not expired. Ms Barrington has not completed the award but is working towards it. She is on schedule to complete within the timescale. YES Condition Compliance 1. Ms Jane Barrington must complete a first aid qualification, that is first Aid at Work by 1st April 2004. 2. Ms Jane Barrington must complete moving and handling training by 1st April 2004. CommentsYES Condition Compliance 1. Ms Jane Barrington must complete a first aid qualification, that is first Aid at Work by 1st April 2004. 2. Ms Jane Barrington must complete moving and handling training by 1st April 2004. CommentsYES Condition Compliance 1. A representative from Advent Estates must be on site in Field Farm House for five days a week for the first month following registration and thereafter for three days a week for the first year following registration. 2. Advent Estates must upgrade the office provision within six months of the date of registration. Comments Advent Estates continue to be present at Field Farm House on a regular basis. The office provision has been upgraded. Lead Inspector Second Inspector Regulation Manager Alan McCardle Date Field Farm House Page 33 Philippa Jarvis Signature Signature Signature Field Farm House ­ 23rd August 2004Public reports It should be noted that all CSCI inspection reports are public documents.Field Farm HousePage 34 Field Farm House ­ 23rd August 2004PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 23rd August 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possible We are working on the best way to include Provider Responses in the published report. In the meantime responses received are available on request.Field Farm HousePage 35 Field Farm House ­ 23rd August 2004Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection reportNOProvider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurate Note: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. Please provide the Commission with a written Action Plan by 16th November 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. D.2 Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESOther: enter details here Field Farm HousePage 36 Field Farm House ­ 23rd August 2004D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Mrs T W Chew of Advent Estates Limited (Field Farm House) confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I Mrs T W Chew of Advent Estates Limited (Field Farm House) am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Field Farm HousePage 37 Field Farm House ­ 23rd August 2004Field Farm House / 23rd August 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000052987.V143635.R01© This report may only be used in its entirety. 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