CARE HOMES FOR OLDER PEOPLE
Field House Care Home 11 Main Road Radcliffe On Trent Nottingham NG12 2FD Lead Inspector
Dee Shelvey Unannounced Inspection 30th January 2006 10:15 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 Care Home DS0000026436.V284740.R01.S.doc Version 5.1 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 Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Field House Care Home Address 11 Main Road Radcliffe On Trent Nottingham NG12 2FD 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) 0115 9335811 0115 Mr R C Pring Mrs P A Pring Mary Patricia Walker Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Terminally ill (4) of places Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. within the total number of beds a maximum of 4 beds may be used for the category TI 16th March 2005 Date of last inspection Brief Description of the Service: Field House Care Home with Nursing was purpose built in 1984 and has been registered since that date. Providing twenty-four hour nursing care for older people the home is located approximately five minutes walk from Radcliffe on Trent town centre and is adjacent to the Grange Community Centre. Easily accessible to the elderly Field House offers accommodation in forty four (44) single rooms and three (3) double rooms. The care home is on two floors with communal areas and bedrooms on both levels, to assist the less able the home has a passenger lift. There are six bathrooms with specialist lifting equipment in place and sufficient well-sited toilets to meet service user need. In addition there are safe enclosed gardens. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over four and three quarter hours and consisted of reading documents, examining records and discussions with the manager. In addition the inspector had lunch with three service users and obtained their opinions on the home. A limited tour of the building took place. What the service does well: What has improved since the last inspection?
Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 6 The care-plans had been improved to ensure that all nursing interventions were included thus ensuring continuity of care. There was evidence of reviews being carried out and of the resident and family being involved in the process. Social activities had been increased with the employment of an activities organiser. This member of staff had already become a favourite with the service users and those spoken with were very complimentary about him. To safeguard the service users the home had consulted with the Fire Authority and done a risk assessment on the wedging open of bedroom doors, which are also fire doors. It was determined that these doors could be wedged open during the day but needed to be closed at nights for safety purposes. This had been explained to residents and some, who previously preferred to leave the door open, agreed to have them closed at nights. A few wanted their doors to remain open and self closure devices ensuring that the door would close if the fire alarm sounded were on order to be fitted. A charge had been made to the service users concerned but after discussions about the homes responsibility to safe guard the service users and meet their needs the manager agreed to ask the proprietors to reconsider. 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 DS0000026436.V284740.R01.S.doc Version 5.1 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 Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Prospective service users are given sufficient information about the home and are assessed prior to admission. EVIDENCE: The statement of purpose and the service user guide were adequate but due for a review. It would be advisable to separate out the 2 documents in order to ensure that both fully meet the standard. The service user case files seen contained full initial assessments on which to base a care plan. They carried evidence of reviews being carried out and of families being involved in the process. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 11. Service users health care needs are set out in a care plan and met. Service users can be assured that at the time of their death they and their family will be treated with sensitivity. EVIDENCE: Three care plans were examined and all addressed health care needs. In one instance it was noted that a service user was losing weight and a referral was made to a dietician. The subsequent advice was recorded and the persons weight monitored, the family was kept informed and were involved in the review of the care plan. All the dietary supplements needed were provided and staff given clear instructions for use. In addition there was evidence of ancillary health care e.g. dental being accessed as appropriate. Field House, as part of the MAY scheme run by Nottingham Health Trust, provides excellent palliative care to patients who would prefer to be in a home rather than a hospital. During their stay the home works closely with a local doctor who visits daily. Families are encouraged to spend as much time at the home as they wish including over night. No charge is made for this and all meals, drinks etc. are provided. Letters from very grateful families were seen.
Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Service users were satisfied with their lifestyles and with the meals offered. EVIDENCE: Service users spoken with were very satisfied with their lifestyles. They confirmed that they were consulted about activities, given the opportunity to access local amenities and one person was able to go to church each Sunday after being put in touch with a local church pastoral scheme. The dining room was clean and well furnished. The layout gave people plenty of room and the size of the tables enables ease of conversing. The service users were given time to have a leisurely meal and any help was given discretely and sensitively. The record of food served showed a variety of nutritious dishes on offer. Mealtimes can be flexible to suit the service user and one person said that, on request, she always had her breakfast in bed. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users were confident that their complaints would be listened to and they were safeguarded from abuse. EVIDENCE: Service users spoken with said they had never had reason to complain but they knew who to go to if necessary. They were confident the manager or any staff member would take a complaint seriously and would seek a resolution. The home had obtained a copy of the Nottingham protection of vulnerable adults procedures since the last inspection and this was available to staff. Many of the staff had recently completed a course on the protection of vulnerable adults and the rest are registered to attend. The aim is to ensure that the whole staff group benefits from training and provides safety through vigilance. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23 and 26. The home offers a good standard of accommodation in a safe environment. EVIDENCE: On the day of inspection the home was clean and tidy without being clinical. The décor and furnishing were of a good quality and in a homely style. There were sufficient numbers of bathing and toilet facilities with appropriate equipment to meet the service users needs. The home had a satisfactory infection control policy and observations of the practice and of the laundry area showed that the policy is followed. The communal areas in the home gave residents choices of where to sit and a small lounge at the front of the building was used for service users to entertain visitors. Those bedrooms seen were laid out to suit the resident and had been personalised. Those service users spoken with said they were very satisfied with their rooms. Where service users wish to leave the bedroom door open at nights it is the responsibility of the home to provide self-closing devices. The garden was well maintained and enclosed meaning residents could use it in safety.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29. The home had sufficient numbers of staff to meet the service users needs and if followed the recruitment policy would offer protection. EVIDENCE: The manager is always supernumerary to the rostered staff giving her appropriate time for all managerial duties. In addition there are sufficient qualified nurses and care assistants on duty throughout the days and nights. If assessed needs show that more staff are required on duty then numbers are increased. Three staff files were examined and contained evidence that the staff recruitment policy was not being strictly followed in all cases. In one file the documents needed to verify identity were missing, another contained only one reference. In all cases a satisfactory criminal bureaux records check had been received. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37 and 38. The manager is a qualified nurse with considerable experience in residential care who runs the home in the best interest of the residents. EVIDENCE: To improve her skills the manager is currently working towards the registered managers award. The office was well organised and records were appropriately stored. Some records could not be made available for inspection because the handyman who had the only key to his storage kept them. The risk assessment carried out on the fire doors was with the proprietors. If someone needs to work with a record away from the office it would be advisable to use a copy; all records must be available for inspection. Those records seen were satisfactory. The home did not have a quality assurance system and this needs to be remedied so that future practice can be based on the wishes of service users.
Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 15 No members of staff were involved with residents’ finances and the home did not hold cash in safekeeping. Staff training needs were audited and a senior member of staff had the responsibility of booking courses or arranging in-house training. Records of training undertaken were kept and the manager ensures that were necessary training is up dated. Staff supervision however needs to be improved to meet the requirement of 6 sessions per year for all members of staff. The manager must implement supervision for the qualified nurses. During the limited tour of the building no potential safety hazards were seen. All potentially hazardous substances were in locked cupboards. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 3 3 1 2 3 Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 13(4)(a) (c) Requirement Where the fire safety risk assessments indicate that bedroom doors left open at night require them self-closing devises must be fitted. Where the fire safety risk assessments indicate that bedroom doors left open at night require them self-closing devises must be fitted. Where the fire safety risk assessments indicate that bedroom doors left open at night require them self-closing devises must be fitted. Where the fire safety risk assessments indicate that bedroom doors left open at night require them self-closing devises must be fitted. Where the fire safety risk assessments indicate that bedroom doors left open at night require them self-closing devises must be fitted. Timescale for action 28/02/06 1 OP19 13(4)(a) (c) 28/02/06 1 OP19 13(4)(a) (c) 28/02/06 1 OP19 13(4)(a) (c) 28/02/06 1 OP19 13(4)(a) (c) 28/02/06 Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 18 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 Refer to Standard OP1 Good Practice Recommendations To separate the statement of purpose and the service user guide to ensure that they both meet the requirements. Field House Care Home DS0000026436.V284740.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Nottingham Area Office 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
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