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Inspection on 25/04/05 for Field House Care Home

Also see our care home review for Field House Care Home for more information

This inspection was carried out on 25th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users stated that they have a good staff team to care for them and that the staff were friendly. The staff team remains consistent as staff turnover is low.

What has improved since the last inspection?

An application has been made to register a manager, this will provide the staff team with the support to meet previous requirements and recommendations from previous inspection reports. Many staff have undertaken N.V.Q. 2 training in care and this will ensure service users have professional and trained carers. Some service users have been supported to have a holiday.

What the care home could do better:

Care plans need to involve service users and need to be reviewed as per individual requirements. Staff meetings must take place at least six times per year. Staff need to have a formal supervision at least six times per calendar year. Monthly quality assurance visits must be undertaken by the owner, records of these visits have to be kept in the home.

CARE HOME ADULTS 18-65 Field House Care Home 127 Foxhall Road Forest Fields Nottingham NG7 6LH Lead Inspector Jeremy Cassidy Unannounced 25 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Field House Care Home Address 127 Foxhall Road Forest Fields Nottingham NG7 6LH 0115 960 3509 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Richard Stevenson & Mrs Alinson Stevenson Miss Estelle Smith Care Home (CRH) 12 Category(ies) of Learning Disabilities (LD), x 12 registration, with number of places Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 7th July 2004. Brief Description of the Service: Field House provides accommodation, support and care for adults with learning disabilities. Service users are supported by the staff to develop their indeprendence skills and with accessing social and leisure activities. The premises comprise of a large semi detached house within a residential area and situated close to bus routes and shops. Accommodation is provided in single and double bedrooms over three stories. The home is presently having an extension built to the rear which will provide an additional sitiing room. Most current service users attend day centres on a part time basis and one is in employment. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted for 5 hours and included inspection of care and other service records, discussion with the duty officer, speaking with 4 service users and 3 staff who were on duty. Professional practice was observed during the course of the day. No relatives or visiting professionals were available to consult with during the inspection. What the service does well: 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. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 There was evidence that policies and procedures have been updated although not yet fully incorporated into practice. EVIDENCE: The home has a statement of purpose which still requires updating, and a service user accessible version has not been developed. A pre-admission form has been devised but had not been completed when a service user recently moved into the home. Four of the service users are aged over 65 and should have their care plans reviewed by the home on a monthly basis, this was not evidenced on files examined. There is an admission and discharge procedure and there was evidence of a service user having introductory visits prior to moving into the home. The home has a service user contract although the contracts viewed needed to be updated to reflect changes in fee’s charged. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 and 10, Service user involvement in care plans and with planning services needs to be developed. EVIDENCE: Whilst care plans contained lots of information there was no indication that this information had been reviewed with the service user. Service users are supported with making choices with and this was observed during the course of the inspection, and through talking with service users present. Service users are consulted with regards some aspects of the day to day running of the home but there are no resident meetings or service user satisfaction surveys to support developing the service. There is evidence of risk assessments being completed but these have not been updated to reflect changes in individual needs. A service user who has recently moved from another care home has a care plan that states that because she has had falls on the stairs she was safer having a downstairs room. This has not been updated since moving to Field house and the service user now has an upstairs bedroom. The home has a missing persons policy which requires the correct phone number contact details for The Commission for Social Care and Social Services adding. Policies and procedures highlight the need for confidentiality although records of a recently deceased service user were not stored appropriately. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,1516 and17 Service users feel well supported by staff at the home. EVIDENCE: Service users have mixed packages of day-care that reflect their individual needs and wishes. The home has not yet written individual timetables of activities that service users access despite this being highlighted in previous inspections. Some Service users are able to access the community independently. There was not detailed evidence of how all service users were able to access community activities and events and this needs to be incorporated into care plans. There is a policy which respects service users rights, and details staff responsibilities with regard to service users relationships. Service users feel that staff are supportive and respectful of their individual rights and needs. Service users are consulted with regards menu’s and state that the meals are of a good standard. Menu’s were varied and nutritious and records kept were of a high standard. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 10 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 and 21 Personal and healthcare needs of service users are met. EVIDENCE: Personal support is given in private and service users are consulted about how they wish to receive their support. All service users are registered with a General Practitioner and supported individually to attend medical appointments. Involvement of specialists in the primary care team is evidenced in the care plans. No service users manage and administer their own medication. Storage for the drugs is provided in a locked filing cabinet and another locked cupboard. Presently there are no controlled drugs used in the home. Senior staff are responsible for medication and have received some training from a Boots pharmacist. Records of medication received and administered are well maintained. Four service users are aged over 65 years. Their changing needs must be reviewed at least monthly and care plans must reflect the changes in action required to continue meeting needs. Service users wishes concerning terminal care and death were recorded on files seen, although one service users wish and that of their families with regards this was contradictory. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 11 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Training has been undertaken by the staff team with regards adult protection. EVIDENCE: There is a complaints procedure in place although there have been no recorded complaints made since the last inspection. There is a copy of the Nottinghamshire Procedure for the Protection of Vulnerable Adults available to staff. It is still required that an appropriate procedure be designed specifically for staff in the home, which will link the home’s Whistle Blowing policy to the area procedure so that everyone is clear about whom to contact, both within and outside the establishment, if abuse is suspected or alleged. Staff reported that they had attended some vulnerable adults protection training although it was not clearly evidenced in training files. The home is aware of the need to notify the Commission under regulation 37 with regards any future allegations of abuse. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30 The home requires further work to meet minimum standards. EVIDENCE: The home is a large house in a residential area. There is a ramped entrance and a stair lifts provide access to the first floor. The laundry room is only accessible via the kitchen, staff report that soiled laundry is transported in sealed containers. Measurements of rooms were not taken on this inspection. One service user used to live independently and now shares a bedroom, this is not an ideal arrangement. One service user reported that he was shortly due to share his room with someone he knew moving from a house due to close. This was reported as being a short term arrangement until a spare bedroom is decorated and needs to be discussed further. Rooms are personalised and furnishings are homely. All areas are carpeted, but some carpets need cleaning or replacing. Curtains and bed linen are of good quality. All service users are supplied with a key to their own room and there are lockable facilities within each room. There are three toilets and two baths for the current 10 service users. The ratios of these facilities to service users is below the minimum standards for Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 13 pre-existing care homes, but the numbers of these facilities have not decreased. Information about the number of baths and toilets should be included in the Statement of Purpose and Service User Guide. There is a lounge, separate dining room and kitchen. There are currently ongoing building works which have taken away most of the rear garden. Staff report that the building will be an additional lounge for the service users. There are stair lifts for those who need them and adaptations in the ground floor bathroom. Individuals have appropriate equipment, such as wheelchairs and walking frames, Handrails and grab rails are in place. The premises are clean throughout. laundry facilities provided remain inappropriate. There is insufficient space, ventilation and capacity and no sluicing facility is provided. Paper towels were not available in any shared hand wash facilities. The stairs to the cellar are steep and there is no handrail, various items are stored in this area and although only staff access this area, a handrail should be fitted. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 There has been progress made in training, contracts and staff files. Team meetings and supervision need to take place. EVIDENCE: Staff have contracts and copies of job descriptions. Each staff member has also been issued with a copy of the General and Social Care Councils Code of Conduct. Staff are aware of their roles and responsibilities. Two staff have completed NVQ level 2 and three others are in the process of achieving NVQ level 2. Staff need to increase awareness of facilities and services for older people with learning disabilities as four current service users are over 65 years of age. Nine care staff are employed and all shifts are covered by existing staff. There are always two care staff on duty, one of whom is a senior worker. Through the night there is one care staff on duty and a senior care sleeping in. There are low rates of staff turnover. Full staff meetings have not taken place, these must be arranged regularly so that a minimum of six per year are held. Criminal Records Bureau checks were on two of the staff files examined, A third file was requested but not available, a copy of the CRB for this member of Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 15 staff must be made available for the immediately. Both staff files had two written references supplied. Each staff member should have an individual training and development assessment undertaken to identify all training required. Staff are still not receiving formal supervision and must have supervision meetings with a senior or a manager trained in providing supervision. Supervisions should be held at least six times a year (pro-rata for part-time staff). Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 and 43 Monthly quality assurance visits need to be undertaken by the owner. EVIDENCE: Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 17 An application has been received to register a manager for the home. It was reported that the manager was undertaking the registered managers award although this could not be confirmed in this inspection. Staff and service users report that generally the home has a pleasant atmosphere and that the staff and owners are approachable. Service user records are held in a locked kitchen cupboard though alternative storage would be more appropriate. It was not evidenced that the homes policies and procedures had been updated or amended as requested in a previous inspection. There were records of a recently deceased service user stored inappropriately in the homes cellar. Evidence is available of regular servicing and checks on equipment. Window openings were not checked during this inspection but a requirement was made with regards to restricting window opening gaps at the previous inspection. There was no evidence that risk assessments had been carried out on radiators as previously requested. Management systems are not in place with respect to staff supervision, and staff meetings have not taken place. Regulation 26 visits by or on behalf of the owner should take place on a monthly basis and a written record of these visits be kept in the home. The registration and training of a competent manager should address many of the management and staffing issues. Appropriate insurance cover is in place and the current certificate is displayed. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 2 2 3 3 2 Standard No 11 12 13 14 15 16 17 3 x 2 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Field House Care Home Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 2 2 2 C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 and 6 Regulation YA1 Requirement Revise the Statement of Purpose to ensure all information specified in Schedule 1 of the Care Homes Regulations is included and is up to date. Revise the Service User Guide to ensure all relevant information specified in Regulation 5 is included and issue a copy to each service user. The manager must develop a consistent format for care plans, so that the action required to meet each need is clarified The manager must establish a system to ensure all plans are kept under review. (Monthly for those over 65 years.) Develop a programme of activities for service users not attending day centres. Risk assessments must be reviewed following falls and accidents, to ensure all possible action is taken to avoid recurrences. An appropriate procedure must be designed specifically for staff in the home, linked to the existing Whistle Blowing policy and to the Nottinghamshire area Timescale for action June 31st 2005 2. 5 and 6 YA1 June 31st 2005 3. 15(1) YA6 May 31st 2005 May 31st 2005 June 31st 2005 May 31ST 2005 4. YA6YA21 YA6YA21 5. 6. 16(2)(n) 13(4)(c) YA12 YA19 7. 13(6) YA23 May 31st 2005 Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 20 8. 9. 10. 13(4)(c) 23(k) 2, 417(2) Schedules YA26 YA30 YA34 YA41 11. 18(2) YA36 12. 13. 23 (4b) 23 (2b) YA24 (11) YA 24 (6) procedure. Ensure staff are trained in the protection procedures. Ensure that radiators are risk assessed and covered where risk is identified. Sluicing facilities must be provided. The manager must ensure staffing records are retained in the home as listed in Schedules 2 and 4 of the care homes regulations. Staff must receive supervision to carry out their jobs, a minimum of six times a year. Ensure a programme of supervision is implemented. Repair broken hinge on fire door on top floor of home. Repair ceiling to bedroom and bathroom on top floor damaged by leaking water. May 31st 2005 May 31st 2005 May 31st 2005 June 31st 2005 25-04-05 31-04-05 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. 6. 7. Refer to Standard YA1 YA2 YA3 YA6 YA7 YA9 YA14 Good Practice Recommendations Use pictorial representations within the Service User Guide and add comments from service users. Develop an assessment format to use for any new admission (where no community assessment is carried out) aswell as for reassessment purposes. Ensure Training at NVQ level 2 includes units relating to Learning Disability. Use pictorial representations to assist service users’ understanding of the care planning process. Provide service users and their families with clear information about independent advocacy services. When recording risk assessments specify action staff must take to reduce or diminish the risk for each risk identified Explore interests and hobbies in more detail with service users. C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 21 Field House Care Home 8. 9. 10. 11. 12. 13. 14. 15. 16. YA19 YA25 YA 26 and 42 YA27 YA32 YA33 YA35 YA39 YA40 17. 18. YA41 YA42 Staff should liaise with district nurses regarding prevention of injuries Explore interests and hobbies in more detail with service users. from falls. When an appropriate single room is available it should be offered to a service user currently sharing. Adjust window opening restrictors to ensure a gap of no more than 100mm (4 ins). Provide paper towels in all communal hand wash facilities at all times. Provide training for staff to increase awareness of facilities and services for older people Hold full Staff Meetings at least six times per year Each staff member should have an individual training and development assessment undertaken to identify all training required. Collate and publish results of the questionnaires used in October 2003. Review all policies annually and reflect the needs and views of current service users as well as current legislation and guidance and ensure all topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65) are included. Find alternative and more appropriate storage for records and policies. Maintain full training records to demonstrate all training given to staff. Field House Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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 Care Home C53 C03 S2249 Field House V223449 250405 Stage 4.doc Version 1.30 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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