Inspection on 17/01/07 for Field House Rest Home

This inspection was carried out on 17th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Field House Rest Home 06/08/08

Field House Rest Home 30/07/07

Field House Rest Home 16/06/06

Field House Rest Home 12/09/05

Field House Rest Home 28/06/05

Field House Rest Home 17/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Field House Rest Home Off Western Road Hagley Clent, Near Stourbridge West Midlands DY9 0HL Lead Inspector Denise Reynolds Unannounced Inspection 17th January 2007 10:55 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 Rest Home DS0000018505.V329700.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 Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Field House Rest Home Address Off Western Road Hagley Clent, Near Stourbridge West Midlands DY9 0HL 01562 885211 * 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) Mr Ernest Michael Lane Mrs Jermaine Kathleen Emily Lane Post Vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54), of places Physical disability over 65 years of age (54) Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also accommodate two named persons aged between 62 - 65 years. 16th June 2006 Date of last inspection Brief Description of the Service: Field House is a care home providing personal care and accommodation for up to fifty-four older people who may have physical disabilities and/or illnesses of the dementia type. It is owned by Mr and Mrs Lane. There is no registered manager at present. There has been an acting manager for over twelve months. Field House is a Georgian style building standing in ten acres of ground. The setting is rural with village facilities nearby. The Home was first registered in 1983 and consists of the original building added to with extensions. The Home is divided into three areas known as the main house, the coach house and the cottage. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Home has not had a registered manager for over a year. The acting manager was recently unsuccessful in her application to be registered and will not be continuing in her current role. On the first day of the inspection the registered manager and joint owner of the ‘sister’ home to Field House (Broome House) met the inspector and explained that she and that her deputy manager are working at the Field House two days a week as an interim measure. CSCI are communicating separately with the service providers about their proposals for the management of both homes. This inspection took place over two days, the first was unannounced, and the second day was pre-arranged with staff. During the two days records and some policies and procedures were inspected, some residents and staff were spoken to and general observations were made of the premises and life in the Home. There were discussions with the acting manager and with the Broome House manager and deputy. There are improvements needed in all aspects of the way the Home is run. The manager from Broome House began her regular weekly involvement at Field House the day before this inspection began. She recognises the size of the task to raise standards and appears to be very committed to achieving this. In view of this we have decided not to take enforcement action on this occasion although a number of requirements have been repeated several times in the last two years. If requirements are not addresses following this report, it is likely that statutory enforcement notices will be issued in respect of some issues. What the service does well: The Home is set in very attractive grounds and because of this there are lovely views from many of the rooms. Staff are friendly and visitors are made welcome. Residents and a relative said the staff are friendly and helpful. Residents are able to bring their own belongings into their bedrooms and many of those seen looked very homely and well personalised. Residents are also able to bring pets with them when they move in and there are currently three small well-behaved dogs. This gives pleasure to the owners and to other residents. Staff speak to residents pleasantly and explain when they are doing something. People said they like the food. A relative said that family members are always made welcome and that they feel free to speak to staff if there is something that needs to be improved. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information provided to residents about the service provided, the Home’s charges and how the Home will deal with complaints needs to be updated and amended to provide clear and accurate information. The management and supervision of care is not well organised or planned. The information about the care each person needs is not detailed enough to guide staff and the records made by staff do not show that the right care is consistently provided. Staff do not always act on the instructions of health professionals or seek advice on health related care needs such as pressure area care. The deputy manager from Broome House has been delegated the task of auditing all the care assessments, plans and records to begin to address this. Residents are not always given the attention and assistance they need with their appearance, personal hygiene and mouth care. More needs to be done to provide enjoyable things for people living at the Home to do. Particular thought needs to be given to how individual people might want to spend their time and to suitable activities for people with difficulties associated with dementia such as memory loss and short attention spans. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 7 The Home has not got satisfactory policies and procedures about safeguarding people from abuse and neglect. Not enough staff have been trained in this essential topic. Staff training is inadequate, not enough staff have had recent training in safety related topics like fire safety, moving and handling and first aid. Care related training other than NVQ has not been done. Staff have not done dementia care training even though many of the residents have difficulties associated with this type of illness. Staff recruitment procedures need to be made more robust so that the risk of unsuitable staff being appointed is minimised. Some parts of the premises need repair or refurbishment. The manager from Broome House started an audit of the premises on 16/01/07 to begin to deal with this. The part time involvement of the manager and deputy manager from Broome House shows that the service providers want to improve the quality of the service at Field House and are taking steps to begin this process. The range of things to be put right is significant and in many instances, longstanding. For the necessary improvements to be achieved, strong and effective leadership from a full time, competent person registered to manage the service is essential. 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 Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not given clear enough information about the service or the charges made. The information gathered by the Home when looking at the needs of a prospective service user is not detailed enough to make sure the person will get the care they need when they arrive. The Home has not demonstrated that it can meet the diverse needs of all the people who live there. EVIDENCE: There are discrepancies between what people have told us about the conditions of residence at the Home and the wording of the ‘Residence and payment of residential fees’ document. For example, a relative told us that the service provider did not initially adhere to the notice period specified in the Home’s contract and Worcestershire County Council have written to the service providers about concerns regarding charges made to residents. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 10 Information about what people have to pay for in addition to the weekly fee needs to be made clearer. For example, people are charged for private chiropody but the document does not mention this. The acting manager confirmed that no action has been taken to review and update the Statement of Purpose – this was a requirement in the last report. Information in pre admission assessments is not detailed enough to give staff the information they need to provide the right individualised care from the moment a person arrives at the Home. The manager from Broome House recognises the failings in these areas and has already taken steps to prioritise and address these – for example a senior member of staff from the other care home has begun an audit of all the care records. Many of the residents need a great deal of care due to poor physical health and/or the effects of dementia illnesses; the lack of staff training and strong management has led to some people’s needs not being met. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of the care records is unsatisfactory and in some cases shows disrespectful attitudes towards people living at the home. The care plans do not give staff a framework to make sure people get care that is safe, meets their needs and takes account of their views and wishes. There has not been strong enough management and oversight of the care to make sure that residents receive the care they need. EVIDENCE: Care plans are not comprehensive and not being used as working tools to guide staff in the care to be given. There was no evidence of involvement of residents and their relatives in the content of the plans. The extent to which residents had been helped by staff to look their best varied. Some looked well groomed but others had not had their hair brushed, some ladies had facial hair, and a number were seen with long nails, some of which were very dirty. During a mid morning tour of some bedrooms dry bars Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 12 of soap and dry, curled toothbrushes were observed on washbasins indicating a lack of attention to personal hygiene and mouth care. Some people at the Home need help with mobility and some fall occasionally. There should be moving and handling and falls assessments in their care plans to make sure staff are aware of how each person should be helped safely and comfortably. These assessments have not been done for some residents. The Home has obtained written consent from relatives for bedrails to be used. They have not done full risk assessments to make sure it is the right thing to do for the individual or to ensure that the correct bedrail is used for the type of bed and that the rails are regularly checked for wear and tear. Staff were not aware of guidance from the Medical and Healthcare Products Regulatory Agency about the safe use of bedrails. The staff consult with District Nurses about care needs such as pressure area care and nutrition, including the introduction of the MUST nutritional assessment tool. This liaison was not immediately apparent from some of the records looked at. It is important to include this information in the Home’s records so that staff have a complete record of the care that is being given. Staff record residents’ weights regularly but an example was seen where there was no information about what was done when a resident was losing weight. A community nurse told us of her concerns that staff were not making sure a resident had enough to drink, had been slow to act when he lost weight and were often disrespectful in the way they spoke about him. The nurse told staff she was going to report the matter to CSCI. She has told us that this resulted in an improvement in the person’s care. The information we found when we looked at the person’s care records supported what the nurse told us. The information in the care plan and daily records was insufficient although there had been recent improvements. Several examples of disrespectful entries in care records were seen. This service user had been seen at the falls clinic but no information was recorded about what advice had been given. The previous acting manager said that the clinic had advised the use of a handling belt when assisting the person to move; this information was not recorded in the care records. The information recorded about the care for a person with pressure area damage was minimal. The record did not provide evidence that regular care was being given or that a district nurse had been informed that the area had been bleeding. This was observed and recorded in the record on 10/01/07 and no further reference was made to this in the record. When this was pointed out, the manager from Broome House said she would be asking the district nurse to visit. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 13 Some aspects of the way medication is dealt with need improvement. Medication was seen being given to people one by one with the record signed straight away; the member of staff explained to each person that she was giving them their tablets. This good practice was let down by the member of staff putting tablets into residents’ mouths with her fingers. The manager from Broome House instructed that this practice should stop immediately. Storage is secure but needs to be tidied up. When the manager from Broome House saw that there were non-medication items (cigarettes and cash) stored in the controlled drugs cupboard she removed these immediately. There was an opened tube of cream in stock. The acting manager was not able to adequately explain why it had been prescribed, what the directions for use had been or whether it was still being used. The manager from Broome House made a note to contact the resident’s doctor to clarify the information. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Steps are being taken to improve the choice and quality of food provided; this should have nutritional benefits for residents and increase their enjoyment of meals. Staff are friendly and welcoming but lack the time to provide a varied, enjoyable and suitable range of things for people to do each day. More attention needs to be given to ways to improve the quality of daily life for people with dementia related difficulties. EVIDENCE: Field House has a friendly atmosphere and a relative and several residents said the staff are kind and helpful. The visitors’ book showed that there is a steady stream of visitors throughout the week and at various times of day. A number of thank you cards and notes in a file in the office contained complimentary messages from relatives and ex staff. There is a limited range of activities – music and movement and bingo - that staff said take place several times a month. One member of staff said she enjoys it when there is time to look at magazines with residents or talk to Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 15 them about their past and would like to be able to do this more. Information about the interests of individual residents is very limited; although the Home has a form for this it is currently underused. The televisions were on in each sitting room during both days of the inspection. They were tuned to programmes that none of the residents appeared to have chosen or were taking an interest in. There was no evidence that thought has been given to tailoring activities to the needs of people with dementia related difficulties. From observation staff are kept busy with personal care duties and with a range of domestic tasks that they also have to do. As a result they do not have much time to spend with residents except at mealtimes or when personal care is being provided. The cook and a kitchen assistant from Broome House are spending two days a week at the Home to supplement the current catering team and develop the food provision. As a result menus have been changed to provide additional choices to residents and new equipment is being obtained to assist in meal preparation. The intention is for more fresh ingredients and home made meals to be provided. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The Home does not have correct policies and procedures and has not arranged for all staff to be trained to make sure that people living in the Home are protected from abuse or neglect. EVIDENCE: The contents of the Home’s policies and procedures about adult protection, complaints and whistle blowing are inaccurate and out of date. They do not give staff the information they need to safeguard people in the Home however well intentioned they may be. Some of the content could lead to staff taking the wrong action – eg investigating a matter that should be dealt with using local multi agency adult protection procedures. The written training information given provided during the inspection showed that only six staff have had training about what to do if they suspect abuse or neglect. One person did this in July 2006 and five in November 2006. Since the inspection the service provider has told us that nine staff did the training in December 2006. Worcestershire County Council adult protection posters were displayed in the Home. Staff spoken to said they would report concerns to the manager but did not know that there is a prescribed procedure to follow when dealing with suspected abuse or neglect. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 17 Complaints records are incomplete and do not show what action the Home has taken when a complaint has been made. One report written by the acting manager demonstrated a dismissive attitude towards the concerns raised by relatives and provided no evidence that the concerns had been properly investigated. Concerns that a relative and a healthcare professional have raised with CSCI and also with the Home were not recorded in the complaints file. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. The service provider has made improvements to the accommodation but further work is needed to make sure the accommodation is of a good standard throughout. Infection control and health and safety arrangements at the Home do not provide adequate safeguards to protect residents. EVIDENCE: The manager from Broome House had begun an audit of the premises the day before this inspection began. She explained that she was identifying a large number of things that needed to be put right to the extent that completion of the initial audit was very time consuming. A partial joint tour of the building was made and a number of shortcomings were identified. These included structural problems such as damp areas on walls, unsecured cleaning products, a bin for incontinence products without a lid, teapots soaking in a bucket in the Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 19 laundry and other matters too numerous to detail in this report. The Broome House manager intended to complete her in depth audit and produce an action plan to make sure all the problems are put right. Because she has this matter in hand we have not detailed each item in our requirements; instead we have made an overall requirement for the premises to be well maintained and have asked for a copy of the premises audit to be sent to us together with the schedule for remedial work. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures are not thorough enough to make sure that only suitable staff are considered for appointment at the Home. There is no structured staff training programme and some staff have not had training in essential health, safety and care related topics. This means that the staff team does not have the full range of knowledge and skills needed to provide high quality individualised care. Planned changes in staffing levels and deployment should assist in the overall improvement of the service. EVIDENCE: CRB checks for British staff have been done correctly and staff do not start work until the full CRB disclosure has been received. The Home requires a police check from the country of origin when appointing overseas staff but has not obtained CRB checks for them. Although there may be no information held about them if they are newly arrived in this country, it is a legal requirement for a CRB and POVA check to be done for all staff working in adult care settings. There was no evidence that a gap in a person’s employment records had been explored thoroughly. Testimonial type references had been accepted for this person and the authenticity of these had not been confirmed. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 21 The manager from Broome House had identified that staffing levels are insufficient for the care needs of residents, the number of residents and the size and layout of the building. She had arranged for staff from Broome House to work some shifts at the Home to supplement the staffing. She explained that she will also be reviewing arrangements for cleaning at the Home. Care staff have been responsible for much of the domestic work in the past. This reduces the time care staff have to spend time with residents and has not been effective as not all areas in the house were clean. Staff moving between care, cleaning and laundry duties also compromises infection control. Information about staff training shows that there are serious shortfalls in the training staff have done. The training matrix provided gives the names of sixteen staff including the acting manager, of these • • • • • • Only 9 have done food hygiene training, Only 8 have done first aid training (2 of these in 2004 and therefore out of date), Only 5 have had training about adult protection procedures, Only 6 had attended a fire safety lecture in the last year, Only 4 staff have been trained in moving and handling but 3 of these had done this in 2004 so the training is out of date, The acting manager has not done moving and handling training and has not taken part in a fire lecture since November 2005. The service provider has informed us that more training is booked in March 2007. No care related training other than NVQ had taken place and staff have not had dementia care training even though a significant proportion of residents have dementia related difficulties. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 22 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): 31,33,36,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service has not had the benefit of strong and consistent management. This has resulted in shortcomings in all aspects of the running of the Home and standards that fall short of those that residents should be able to expect. EVIDENCE: As described in other parts of the report, the new management team are taking proactive steps to address the longstanding concerns about the service and expressed a desire to work in co-operation with CSCI to put the Home on a sound footing and improve the service provided. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 23 To date there has been no quality assurance system at the Home; the manager from Broome House recognised that the principles of quality assurance can help her to address the things she needs to do at the Home. Staff have not had regular individual support and development meetings (supervision) with the acting manager. Record keeping at the Home is not adequate, specific details are referred to in the relevant sections of the report. Training in health and safety topics such as fire safety, moving and handling, adult protection has not been given to all staff. For example more than half the staff have not attended a fire lecture for over a year, one person has not done so for 5 years and four have not yet attended one at all. Cleaning materials were found in bathrooms where residents would have easy access to them, this is a particular risk in homes where people with dementia live. Although liquid soap and paper towels have been provided in bathrooms and toilets, tablet soap and fabric towels were also still available. These pose an infection control risk in communal facilities and should not be in use. A requirement about residents having access to their spending money was not reviewed during this inspection but the service provider has confirmed that the senior on duty on each shift is able to provide residents with their money on request. Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 24 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 2 2 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 1 1 Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4 Requirement The statement of purpose must contain all the information listed in schedule 1. (Previous timescale of 30/6/06 not met). The statement of terms and conditions for residents must be clear about the overall care and services covered by the fee, and additional services to be paid for over and above those included in the fees. (Previous timescale of 30/09/06 not met) Pre-admission assessments must include all the areas listed in standard 3.3 and be sufficiently detailed to give staff the information they need to provide the right individualised care to a person when they arrive at the Home. (Amended requirement, previous timescale of 16/06/06 not met) All the needs identified in preadmission assessments must be translated into a care plan. (Previous timescales of 4/4/06 and 16/06/06 not met) DS0000018505.V329700.R01.S.doc Timescale for action 31/05/07 2 OP2 5 schedule 4 (8). 30/04/07 3 OP3 14 16/02/07 4 OP7 15 16/02/07 Field House Rest Home Version 5.2 Page 26 5 OP7 13 6 OP8 17(1)(a) Schedule 3 7 OP10 12 8 OP12 16(2)(n) 9 OP16 22 10 OP16 22 11 OP18 13(6) Risk assessments relevant to individual residents (eg use of bedrails, moving and handling, pressure area care, nutrition and others identified) must be must be carried out and recorded in their care records. (Amended requirement, previous timescale of 16/06/06 not met) There must be clearer evidence in the daily care records to show how residents’ care needs are being met. (Amended requirement, previous timescale of 16/06/06 not met) The promotion of residents’ dignity by attention to personal appearance, personal hygiene and oral care must be improved. Arrangements for providing suitable and enjoyable activities for residents must be reviewed with particular attention given to the needs of people with dementia related care needs. (Amended requirement, previous timescale of 30/09/06 not met) The complaints procedure must be re written so that it contains full and correct information about how someone can make a complaint and how this will be dealt with. All complaints must be recorded. The record must include details of the action the Home has taken to investigate and the response to the person making the complaint. (Amended requirement, previous timescale of 16/06/06 not met) There must be one adult protection policy and procedure drawn up in line with the local authority’s procedures. Policies and procedures referring to internal investigation of allegations of abuse must be DS0000018505.V329700.R01.S.doc 28/02/07 16/02/07 16/02/07 30/04/07 31/03/07 16/02/07 31/03/07 Field House Rest Home Version 5.2 Page 27 12 OP18 13(6) 13 OP18 13(6) 14 OP19 13, 16 and 23 15 OP29 19, schedule 2 16 OP29 19 17 OP29 19 18 OP30 18 removed. (Previous timescales of 31/8/05, 31/10/05 and 30/06/06 not met). All staff must receive training in adult protection. (Previous timescales of 30/9/05, 31/12/05, 30/06/06 and 30/09/06 partly met). The whistle-blowing policy must be altered to comply with the Public Interest Disclosure Act. (Previous timescales of 31/12/05, 30/06/06 and 30/09/06 not met). The premises, fixtures, fittings and furnishings must be maintained in a good state of repair and replaced where necessary so that residents have safe and comfortable surroundings. (We have asked the provider to send us a copy of the premises audit being done by the Broome House manager.) The recruitment process must meet the requirements of the regulations (as amended in 2006). All the information listed in schedule 2 must be available on every staff file (including staff recruited from overseas). (Amended requirement, previous timescales of 04/04/06 and 16/06/06 not met). POVAfirst checks must be obtained for all staff working at the Home with overseas police checks whilst awaiting receipt of CRB disclosure certificates. Reasonable steps must be taken to establish the authenticity of references. Testimonial style references should not be accepted. All staff must receive training in care topics relevant to the DS0000018505.V329700.R01.S.doc 30/04/07 31/03/07 31/05/07 28/02/07 28/02/07 28/02/07 31/08/07 Page 28 Field House Rest Home Version 5.2 19 OP38 13, 18 20 OP30 18 21 OP33 24 22 OP36 18 23 OP38 13(4)(c) 24 OP38 23 (4a) Home’s statement of purpose and registration categories and their role at the Home. Dementia care training must be included if the Home intends to continue to admit people with this type of care need. (Amended requirement, previous timescales of 31/8/05, 31/12/05, 30/06/06 and 30/09/06 not met). Staff must receive training, in mandatory health and safety related topics relevant to their role at the home including fire safety, first aid, moving and handling, food hygiene and infection control. Arrangements for this training must be made by the date stated. Staff must be given suitable assistance, including time off, to enable them to take part in training. A quality assurance system must be fully established in accordance with the requirements of regulation 24 and standard 33. (Previous timescale of 30/09/06 not met) Arrangements must be made to ensure that staff receive structured supervision. (Amended requirement, previous timescales regarding staff supervision of 31/8/05, 30/11/05 and 30/09/06 not met). All substances hazardous to health must be securely stored. (Previous timescale of 16/06/06 not met) Where the Regulatory Reform (Fire Safety) Order 2005 applies to the care home the registered person must ensure that the requirements of that Order and DS0000018505.V329700.R01.S.doc 31/03/07 28/02/07 30/04/07 30/04/07 16/02/07 28/02/07 Field House Rest Home Version 5.2 Page 29 any regulations made under it, except for article 23 (duties of employees), are complied with in respect of the care home. (This relates to the lack of training for staff in fire safety.) 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 OP2 Good Practice Recommendations To ensure that the content of the ‘Residence and payment of residential fees’ document is clear, unambiguous and fair, the required improvements should be made with reference to the report from the Office of Fair Trading on care home contracts. It is important that the care records show when advice has been sought from relevant health care professionals about health related needs (eg pressure area damage, weight loss, falls). This will help make sure that full information is available about the care being given. All staff should have individual training and development profiles to assist in planning and monitoring the training needs of the staff team and individual staff members. Planned, individual support and development meetings should form part of the overall arrangements for the training and supervision of staff. 2 OP8 3 4 OP30 OP36 Field House Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Rest Home DS0000018505.V329700.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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