Inspection on 16/04/08 for Field House

This inspection was carried out on 16th April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Field House 18/04/07

Field House 18/04/06

Field House 17/11/05

Field House 20/07/05

Field House 24/11/04

Field House 28/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Field House Fleet Hargate Nr Holbeach Spalding Lincs PE12 8LL Lead Inspector Alison Jessop Unannounced Inspection 16th April 2008 10:00 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 Field House DS0000002357.V362531.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. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Field House Address Fleet Hargate Nr Holbeach Spalding Lincs PE12 8LL 01406 423257 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) Farrington Care Homes Limited Mrs Karina Irene Naomi Elves Care Home 28 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (26) of places Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care to service users whose primary needs fall within the following category: Old age, not falling into any other category (26). Dementia, under the age of 65 years (2). The maximum number of service users to be accommodated is 28. 2. Date of last inspection 18th April 2007 Brief Description of the Service: Field House is a former farmhouse built in 1935. The home has been adapted and extended to provide care and accommodation for 28 service users over 65 years, 2 of these having dementia. The home is situated in the village of Fleet Hargate, approximately 4 miles from Holbeach and its shops and facilities, and is set in approximately 2 acres of landscaped grounds and gardens. It is approached from a private driveway with parking to the front of the property. There are 20 single, and 4-shared bedrooms, which are located on the ground, first and second floors and accessed by stair lifts. The home has a lounge, separate sitting and dining room and a large heated sun lounge. A copy of the last inspection report can be located in the reception area of the home and a copy of the Service User Guide and Statement of Purpose can be obtained from the Registered Manager. The care fees range from £455 to £477 per week. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. One Regulatory Inspector carried this unannounced inspection out over five hours. Throughout this report the term ‘we’ is used to describe the inspector. We looked in detail at the care received by three residents, this process is called ‘case tracking’. We gained feedback from the residents and/or their relatives, we looked at their care records, medication records and generally observed what life is like for them living at the home. We gained feedback from eight residents and two relatives. We also interviewed two staff and gained feedback from the Registered Manager. A tour of the premises was undertaken and other records, policies and procedures and administrative systems observed. We also looked at information provided by the Registered Manager on the Annual Quality Assurance Assessment (AQAA). What the service does well: Field House provides a comfortable, homely environment to its residents. People who live at the home said that they receive good quality care from a caring team of staff. One resident said ‘I am very happy here, the carers are wonderful, they do so much for me.’ A relative said ‘we are very happy with the care provided, we have no complaints about the care at all.’ The health care needs of residents are met and residents have access to a wide range of healthcare services such as district nurses, opticians, dentists and dieticians. The residents have access to a variety of communal areas, one being a very large conservatory which over looks the garden. There is a range of activities available and residents said they are able to go out to church and receive visitors to the home at any time. Residents reported that the food is very good and that they are consulted with about the menus. There is plenty of food and drinks available throughout the day. One resident said ‘the food is very good and what I like the most is that I can more or less do what I want.’ Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process to assess resident’s needs ensures that their needs can be met and that they will receive the right level of care. EVIDENCE: A detailed assessment is undertaken of prospective residents needs and a decision is made about suitability. A discussion was held with the Registered Manager who was very clear about the admission process as she ensures that the persons needs can be met before agreeing to admission. The information gained during the assessment forms part of the individual care plan. The service does not provide intermediate care. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home receive good quality, individualised care and are treated in a dignified and respectful manner. EVIDENCE: Each resident has an individual, person focussed care plan, which is reviewed on a regular basis. The majority of care plans had been agreed by the resident or their representative. One relative said ‘we have read through the care plan and we attended a review a few months ago. We are happy with the care plan and like to be consulted about any changes.’ The care plan describes the resident’s health and social care needs and includes choices and preferences made by the resident. Residents said that their health and care needs are met. One resident said ‘the care staff help me to get washed and dressed, I have a bath which I really enjoy. I can say that they look after me very well.’ Residents have access to healthcare services and the wellbeing of the residents is monitored closely. Food and fluid intake monitoring, weight monitoring and pressure sore Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 10 prevention is undertaken to promote good health and well being however there was a lack of comprehensive risk assessments. For example one resident whose weight is being closely monitored and who is on food and fluid intake monitoring did not have a risk assessment in relation to risk of malnutrition. Another resident who has a long history of mental health illness did not have a risk assessment in relation to this. Procedures relating to medication are satisfactory. Two homely remedies were found in the medicine cabinet however there were no records relating to these. The Manager took action to ensure the correct procedures are followed and therefore a requirement has not been made. Residents said that they are treated with dignity and respect. A knock and wait policy was observed by staff when entering residents bedrooms. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home have access to suitable stimulation, they are able to make choices and express their preferences, which are usually accommodated. EVIDENCE: The residents spoken to said that there are organised activities on a regular basis. On entry to the home there is an activity plan for the week displayed on the wall. One resident said ‘there’s lots of entertainment we like to play bingo every week and we made some Easter Bonnets at Easter which was nice.’ On the day of the inspection it was Bingo day and most of the residents seemed very enthusiastic about this. Throughout the day residents were observed reading newspapers, crocheting and socialising with each other. Some of the residents preferred to stay in their bedrooms however staff were observed encouraging them to participate in the communal activities. Visitors are welcome to the home and some residents said that they go out independently. One resident said ‘I go to church on Sundays on my scooter without staff.’ Relatives spoken to said ‘we can visit whenever we want, they Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 12 prefer not to have visitors around meal times but we do sometimes come at meal times and they don’t seem to mind this.’ Residents spoke highly of the choice and variety of food. One resident said ‘they asked what we would like on the menu and I quite like curry, this is now offered every week along with other foods that we suggested.’ The lunch on the day of the inspection was a choice of roast beef or chicken curry. Residents are asked which dinner they would like on the same morning. Between meals a range of hot and cold drinks, snacks and fresh fruit were available to residents. One resident said ‘sometimes the morning coffee and biscuits is served late, then the lunch is served at midday which means we are not always hungry.’ Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home are protected by the safeguarding procedures in place. Residents and relatives can feel confident that their concerns and complaints will be dealt with appropriately and in a timely manner. EVIDENCE: The home has a robust complaints procedure and all residents and relatives spoken to were aware of how to raise concerns or make a formal complaint. The service has received five complaints in the last 12 months. The majority of these were relating to the food. The Manager has implemented a system for consulting with the residents about the menus and residents appear to be generally satisfied with the food now. The Manager records all complaints and concerns received and has ensured that complaints have been resolved satisfactorily and within an acceptable timescale. Staff spoken to were aware of the Safeguarding Adults procedures however the Manager has arranged more training in this area. Two safeguarding investigations have been held in the last 12 months however none of the allegations were substantiated. All staff working at the home has been subject to an enhanced Criminal Record Disclosure and satisfactory references sought, this protects residents from harm. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Field House provides a comfortable, homely environment to the people who live there. Although the home is generally clean, staff do not always follow good infection control procedures, which creates risks to service users, staff and visitors. EVIDENCE: The home is attractively decorated to suit the age of the building. Some areas of the ground floor hallway are in need of redecoration as the wallpaper is torn and looks unsightly. The Manager stated that some of the bedrooms have been redecorated and the hallway redecoration is being planned. Resident’s bedrooms are cosy and nicely decorated and contain personal items such as soft furnishing, pictures and ornaments. The home has a comfortable lounge area and a very large conservatory which over looks the garden. Residents were observed enjoying their lunch in the Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 15 conservatory and said that it is particularly pleasant during the summer months. A new bath has been fitted in the ground floor bathroom as a result of listening to people who use the service. During the morning of the inspection, we noticed several items of soiled laundry on the floor in bedrooms and in the laundry room. Used bars of soap were also observed in communal bathrooms. One member of staff was also observed carrying soiled linen into the laundry, through communal areas without being contained. The Manager stated that all staff are currently commencing training on infection control procedures and that she would remind staff about this. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty throughout the day and night to ensure resident’s are safe. Insufficient staff training puts resident’s at risk. EVIDENCE: Staffing levels are adequate and meet the needs of the people currently living at the home. The rota is planned around busy times of the day and extra staff are on duty during the morning and evening, which enables residents to have assistance with bathing. One the day of the inspection there was one staff short however the team appeared to manage very well. The Manager was also available to help out and was observed assisting the staff to ensure that resident’s needs were met. The Annual Quality Assurance Assessment reports that out of seventeen staff, thirteen have achieved or are currently working towards an NVQ qualification. The service has a robust recruitment procedure and staff are vetted prior to working with residents. This means that a Criminal Record disclosure and at least two references are obtained. The service has implemented a more robust interviewing process, which will further protect the people receiving care. Although there is a staff training programme, it was difficult to establish which staff had completed specific mandatory training. There were very few Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 17 certificates however the manager was aware that there are gaps in the training programme and plans to deal with this. The moving and handling training currently consists of watching a video and completing a questionnaire, the Manager needs to consider that this may not be adequate where residents develop complex moving and handling needs. All staff have attended dementia care training and those spoken to gave examples of ‘good practice’. Staff have not had training in Infection Control Management. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has implemented new procedures within the home and has supported staff through change and ensured they are aware of current legislation. EVIDENCE: The Manager of the home was available throughout the inspection and was observed moving around the home and talking to the residents. One relative said ‘if we ask the Manager about something or raise a concern we know she will do her best to resolve things.’ The Manager is currently completing her Registered Managers Award. The Annual Quality Assurance Assessment was completed within the requested timescale however information provided was minimal and did not give a clear picture of how peoples needs are being met. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 19 The Manager stated that the completion of the AQAA would have been easier if she had access to the Internet and the guidance provided. The Manager has done some research on the Mental Capacity Act which is new legislation introduced in October 2007. She has gained information about the Act and how it will affect the service. She has liaised with the local authority and has made this an agenda item at the next team meeting. Care plans are due to be reviewed in accordance with the requirements of the Act. Although the service has an informal quality assurance process, formal quality monitoring is not taking place regularly. It was evident that residents had been asked their views about the food, and other areas however a formal survey is not carried out with residents and relatives on a regular basis. Residents meetings do not occur regularly, the previous residents meeting was held in October 2007. Although staff receive supervision, this has not been carried out regularly with staff. Satisfactory procedures are in place to safeguard resident’s money. Records are maintained of any transactions and residents have access to their money as required. A risk assessment has been undertaken of the premises and equipment within the home. Staff have received training on health & safety. Policies and procedures are available to staff to assist them to carry out their work safely. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 13 (4)(C) Requirement Care plans must include a comprehensive risk assessment where areas of risk are identified for example prevention of malnutrition or supporting someone through a period of mental ill health. Staff must work in accordance with current infection control guidelines in order to prevent cross contamination and infection. The ground floor hallway must be redecorated where the wallpaper is torn. All staff must attend regular mandatory training, i.e. Infection control, moving and handling and fire safety. Timescale for action 31/05/08 2. OP26 13(3) 31/05/08 3. 3. OP19 OP30 23 (2)(b) 18(1)(c) (i) 16/10/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Field House Refer to Good Practice Recommendations DS0000002357.V362531.R01.S.doc Version 5.2 Page 22 1. Standard OP15 2. OP36 Quality Assurance processes should be undertaken more regularly. Surveys, residents meetings and team meetings should be undertaken to ensure that the quality of the service is reviewed and any improvements implemented. Staff supervision should be undertaken at least six times annually. Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Field House DS0000002357.V362531.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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