Inspection on 30/07/07 for Field House Rest Home

This inspection was carried out on 30th July 2007.

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

Other inspections for this house

Field House Rest Home 06/08/08

Field House Rest Home 17/01/07

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 Key Unannounced Inspection 30th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Field House Rest Home DS0000018505.V338795.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.V338795.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 Vacant post 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.V338795.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. Date of last inspection Brief Description of the Service: Field House is owned by Mr and Mrs Lane and is a care home registered to provide care and accommodation for up to fifty-four older people who may have physical disabilities and/or illnesses of the dementia type. Field House is a Georgian style building standing in ten acres of grounds. The setting is rural with village facilities nearby. The Home was first registered in 1983 and is divided into three areas known as the main house, the coach house and the cottage. The main house has large rooms, high ceilings and a large wide staircase while the coach house and cottage are smaller and more domestic in style. People who live at the home all have their own bedroom unless they are couples or friends who wish to share a room. The home has a pleasant courtyard garden. To the front of the home there is a parking area for several cars. Mr and Mrs Lane also own The Coach House a nearby care home that provides nursing care for 17 people. They recently closed their third Home (Broome House) and the manager (Tanya Bradley) and some staff have moved to work at Field House. Tanya Bradley is the registered manager of The Coach House and has started the process of applying to be registered in respect of Field House as well. The fee level for the home is £390 to £460 per week for people who move to the Home now. Some people who have been at the Home for some time pay less than this. The fee takes into account the size of the room occupied and whether it has ensuite facilities and does not include extra services such as hairdressing, chiropody and toiletries. These are all available at extra cost to people who live in the Home. The service providers inform people in the terms and conditions for the Home that they may also make an additional charge for electricity if fuel prices rise. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection – this is an inspection where we look at a wide range of areas covered by the National Minimum Standards. We did the inspection over two days. On the first day one inspector was at the Home during the afternoon and early evening and on the second day was there from midmorning until late afternoon. A specialist pharmacy inspector also went to the Home on the second day to inspect the way the Home manages medication. To help us plan the inspection we looked at information in the service providers Annual Quality Assurance Assessment and in an improvement plan they sent us after the previous inspection. We also took into account what people told us in our survey forms; we received these from seven people who live at the home and from seven relatives. During the visit we spoke privately with five people in their rooms. We looked at the accommodation and spoke with the manager, service providers and some staff. We inspected various records including a sample of care records and staff records. What the service does well: Field House is set in very attractive grounds and people told us they enjoy the lovely views from many of the rooms. Staff are friendly and visitors are made welcome. People are able to bring their own belongings into their bedrooms to help make them feel it is theirs. People are also able to bring pets with them when they move in and there are currently three small well-behaved dogs at the home. This gives pleasure to the owners and to other people living there. If the owner is not able to take the dog for a walk, staff help them to do this. Staff speak to people politely and are gentle with them. People told us they like the food most of the time and appreciate the fact that if they ask they can have meals at a different time from other people. Some people told us that they have lots of confidence in the manager and owners and can tell them if something is wrong. One relative told us the Home is good at keeping in touch with them – ‘We are always advised of appointments, referrals, changes in Mum’s condition or changes to her care.’ People told us they felt they had made a good choice of Home and like living there. One of the relatives who sent a survey form back commented – Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 6 “It provides a very pleasant comfortable Home for people who need care. The staff afford them the respect and dignity due especially to old people.” What has improved since the last inspection? The management and supervision of care is better organised than it was. Staff are better at seeking prompt medical attention if someone is not well and the care records are better organised. Steps are being taken to provide enjoyable things for people living at the Home to do. More thought is being given to how individual people might want to spend their time. More information is available about safeguarding people from abuse and neglect and all the staff are being given training about this so they would know what they should do if they had concerns about someone’s welfare. More staff training is being done in safety related topics like fire safety, moving and handling and first aid. There are more people working at the Home who have NVQ qualifications. Staff are now having training about dementia care to help them understand the difficulties people with this type of illness have to cope with. Although no new staff have been appointed the manager is committed to using robust staff recruitment procedures. CRB checks have been obtained for overseas staff already working at the Home to ensure that they have not been convicted of any offence in this country. The service providers have spent a lot of money improving the accommodation. Many rooms have been redecorated and new furniture, bed linen, curtains and carpets have been provided in many rooms. Work has started on building a new laundry and more rooms have ensuite facilities provided. The new manager has been instrumental in achieving many of the improvements and has been supported by the service providers and staff. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 7 What they could do better: Following the previous inspection, the range of things that needed to be put right at the Home was significant and in many instances, longstanding. The progress made since then is encouraging but it is essential that this is sustained and developed. If the Home is going to continue to accommodate people with dementia type illnesses they need to find out more about recognised best practice in this area of care, including care practice, communication, training and how the environment can be used to help people. The service user guide needs to include more information, including the terms and conditions, complaints procedure and most recent CSCI report, to help people make a choice about whether they want to go there. The guide should explain how the staff assist people with specialist care needs such as the effects of dementia type illnesses. Some improvements are needed in respect of the basic day to day care experienced by some people. To assist with this the care plans should continue to be developed to make sure they provide a clear and up to date to keep staff well informed about the care each person wants and needs. Specific shortcomings in the way medication is being managed were identified; the manager gave strong assurances on the day of the pharmacy inspection that these would be rectified and has subsequently confirmed by telephone that all the issues have been corrected. The full Worcestershire multi agency adult protection policy and procedures needs to be readily available to staff together with practical written guidance for staff about who to contact. The manager needs to taken part in the adult protection training sessions so that she is aware of the course content and can assure herself that it is compatible with the multi agency policy and procedure. The Home has experienced staffing shortages at times and this has been noticed by people living at the Home and their families – ‘The carers always try to meet my mother’s needs. The only time they are unable to is when staff levels do not allow this.’ Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 8 The service providers are currently advertising for more staff to improve this situation. 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.V338795.R01.S.doc Version 5.2 Page 9 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.V338795.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager visits people who are thinking of moving to the Home to find out what care they will need and to make sure the Home can provide this. Some information is provided to help people decide if the Home will be the right place for them to move to. EVIDENCE: The Home has a statement of purpose and people who enquire about living there are given a brochure (we call this the service user guide). These need to give people more information about the level of service and care they can expect at Field House. People are not given a copy of the most recent inspection report unless they ask for it. Mr and Mrs Lane reviewed the terms and conditions (contract) document earlier in 2007 to inform people that they may be charged an additional amount for chiropody and electricity. The manager confirmed that the terms and conditions for the Home are currently sent to people with their first Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 11 account. This is too late for people to find out what the terms and conditions are; this information should form part of the service user guide. Just over half the surveys from people living at the Home indicated that they have not had this information. When people are thinking of moving to Field House the manager visits them to find out about the care they need. People and their relatives are encouraged to come and look around before deciding whether to move in. We looked at the information the manager had gathered about people who had moved in recently; this was detailed and informative. The manager needs to amend the form because at the moment it doesn’t give her enough space for all the information she includes and this makes it hard to read. When a person arrives staff add to the original assessment using a second set of forms and then later they compile a more detailed written plan for the person’s care. We saw that this had resulted in some information being duplicated or being slightly different. This could confuse staff about which information they should follow. This was discussed and the manager is going to review the paperwork used. Each file seen had a quality assurance questionnaire in it; the manager agreed that it would be beneficial to add questions about how the Home deals with the period when someone first has contact with and moves into the Home. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager has improved the management and oversight of care and further developments are planned so that people living at Field House can be confident they will always receive care that meets their needs and takes account of their views and wishes. Some aspects of the medication systems are poor and could result in errors. EVIDENCE: The manager has improved the management and oversight of care since the previous inspection. She has introduced a daily allocation system to ensure that staff are clear about their responsibilities during each shift and are accountable for shortfalls in standards of care. The written care plans and daily records have improved. The care plans still lack detail and included generalised statements about the care needed rather than describing the specific care each person needs. Staff use a monthly review sheet in each persons’ file to note changes. Staff had written about a Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 13 significant change in one person’s care but they had not changed the actual care plan. We could see from the records that staff are giving the correct care, nevertheless it is important to update the care plan to make sure staff have the right information. We found examples of staff noticing when someone is unwell and calling in healthcare professionals promptly. Some relatives mentioned this in their survey forms – “As far as I am aware they meet her needs in regards to her age and medical conditions” “They have responded promptly with any issue I have had ………..; by seeking appropriate medical advice at the earliest opportunity” The manager has acted to improve several areas of care practice, for example, • The use of bedrails, where risk assessments and maintenance records are now in place. • Pressure area care, where equipment is available or obtained promptly. • Nutrition and weight concerns, where better records are now kept and the catering staff are aware of their role. Some aspects of the records still need to be improved, for example a care plan did not provide clear information about the pressure relieving equipment provided for one person. People living in the Home and their relatives are not yet all fully involved in discussions about their care and what needs to be in their care plans. The manager knows that this needs more work. Some of the survey forms we received showed that some people feel there is still room for improvement in the care. For example, while all the service user surveys we received said that staff always listen and act on what the person says, only a quarter feel they always get the care they need, with the rest saying that they usually do. This was echoed in the surveys we had back from relatives “They attempt to sort out any problems. But this does, sometimes take longer than one would wish” “There is often a need to remind them of any request” Most people looked well looked after and had clean clothing, tidy hair, manicured nails and so on. A relative made a comment about this in a survey form – “Residents appear to be well dressed, gently dealt with …” However, this was not so in all cases and, as at the previous inspection, some people looked unkempt. We asked the manager to observe one person who had long and dirty finger nails and then look at the care records with us. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 14 These records provided no insight into why the person’s appearance was as it was and the manager agreed that this was an area needing more work. During the two days we saw and heard staff as they assisted people and on each occasion they were gentle and polite to the people they were caring for. The people spoken to said they were happy with the care they receive and like the staff. One relative’s survey contained the comment – “It provides a very pleasant comfortable Home for people who need care. The staff afford them the respect and dignity due especially to old people.” The following information relates to an inspection of the medication systems in the Home by a specialist pharmacy inspector: The medicine policy is brief and does not fully reflect how the service manages service users medication. The manager agreed that the procedure needs to be revised to support good practice. Staff who administer medication have recently undertaken training on the safe handling of medication. Medication is securely stored in two main locations in the home. Medication storage has been improved by providing separate storage in the ‘Cottage’. Locked medicine trolleys are used to store all peoples’ current medication; these are secured to a wall when not in use. Two locked refrigerators are used for medication requiring cold storage. There were no temperature records for the refrigerators which meant that it was not possible to check that medication is stored at the correct temperature. We observed staff administering medication in both parts of the building. Staff carried medication to people in a medicine pot rather than taking the trolley. One member of staff confirmed that this is a regular practice at the Home. This system of medication administration increases the risk of a medication error. Four people administer their own medication and have safe storage for them in their bedrooms. There were risk assessments available and the care plans reflected the individual arrangements for self-administration. One person said ‘I am happy looking after my own tablets’. Staff are not recording the date they give people a new supply of medication. This would help staff check that people are taking their medication safely. We saw all of the medicine charts for the current month. The majority were pre-printed by the pharmacy, however some had to be hand written by members of the staff team. The hand written charts are not all dated and some do not include the name of the resident’s General Practitioner (GP). Some staff are not recording the amount of medication administered on the medicine charts. For example, one service user is prescribed a painkiller, ‘One or two to be administered four times a day when required’, however staff had not recorded whether they have taken one or two. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 15 Some staff are not signing when they give someone their medication nor entering a code with a reason why medication has not been administered. For example, staff had not signed for the administration of three doses of a person’s antibiotics on 30/7/07. A check of the remaining antibiotic capsules indicated that the three capsules had been removed from the pack but there was no way to tell if the medication had been administered or refused. Staff are not recording when people have prescribed creams and ointments put on. Some staff are recording confusing information on some medicine charts, this could lead to a medication error. In one example, staff sometimes recorded the quantity of tablet given but at other times they recorded the dose. This is particularly concerning as the medication concerned would affect the quality of life of the individual if it is administered incorrectly. Accurate records of received medication were available but improvements are needed to provide a full audit trail of medication administered and in stock. For example, staff have not always been recording the date of opening on medication containers and have not always carried over balances of medicines onto the new record chart. We checked the balances of some medicines and the majority of these were accurate. All of the concerns regarding medication were discussed in detail during feedback with the manager who provided very strong assurances on the day that remedial action would be taken immediately. She has since confirmed by telephone that all the issues have been attended to. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The importance of nutritious enjoyable food is recognised and people at the Home receive a balanced diet. Some people would like to have more things to do during the day and an activity organiser has been employed to improve this part of peoples’ lives. Visitors are made welcome at the Home so that people can keep in touch with the people who matter to them. EVIDENCE: Information in the surveys told us that some people feel there needs to be more to do to pass the time. They made comments such as – “ The provision of more activities for the residents.” “Perhaps provide activities to try and keep him mentally stimulated” “ It would be good to have more activities” “ Through no fault of the staff, I think a more varied range of activities could be introduced – perhaps to suit different requirements of individuals. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 17 We saw that the people able to get about themselves are encouraged and supported to be independent, for example by being able to choose where they spend their time during the day, and by looking after their own medication. However, the people who need more support spent periods without much contact from staff who were very busy and appeared to have limited time. The service providers have recently employed an activity organiser to improve this situation. She has begun to introduce extra things for people to do. She is planning to contact the relatives of people who have dementia illnesses to gather more information about the lives of those people. This is so she can include more information in the care plans about how each person might enjoy spending their time. The activity organiser has previously worked in care settings for people with dementia illness and has done some one day courses on the subject. She was not aware of some sources of information about best practice in dementia care. It would be beneficial for her to develop her knowledge and awareness of best practice by doing a more in depth course. Some of the surveys provided evidence that staff do their best to make life pleasant for people – “They remember birthdays with a cake. Many of the carers will sit on the bed for a little chat.” “It is very difficult to realistically provide the lifestyle he would ultimately choose. Insofar as they are able to they try to accommodate all his wishes.” Some people described ways that staff spend individual time with people when they have time such as taking people for walks in the grounds. The Home has a policy of allowing people to bring their pets with them to the Home and as a result has three dogs that the staff take for walks if the owners are unable to. The menus showed a varied and nutritious diet and one of the cooks said the food is all homemade and they have regular deliveries of fresh meat and produce. Staff are flexible about what time people eat, for example, two people had their tea cooked individually after others had eaten. This was because one prefers his meal later and another because he asked for something different from what was on the menu. The Home has worked with healthcare professionals to increase staff awareness of nutrition, weight and overall well being. We saw evidence of this in the care records and spoke to one of the cooks who was well informed about this subject and able to describe changes made to a person’s diet due to concerns about their weight. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress is being made in raising staff knowledge and awareness about what to do if they believe someone has suffered abuse or neglect. Most people who use the service know how to make a complaint and who they can speak to if they are not happy. EVIDENCE: Most people who returned surveys said they know who to complain to if there is something they are not happy with and the people spoken to said they would have no hesitation in speaking to Tanya Bradley or Mrs Lane. This was echoed in the following comment in a survey form – “ In the unlikely event of this happening I would simply go in and speak to the supervisor in whom I have complete trust” There is a complaints procedure that meets the requirements of the regulation. And this is displayed in several places in the Home. This could be improved by being written in a more friendly tone to reassure people that their concerns will be taken seriously and that they will not be adversely affected if they complain. One relative wrote – “ She feels always very reluctant to make any sort of adverse comment in case they are not nice to her. I do feel this is a very common thing among many older people” Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 19 Whilst this may not be a well founded perception of what would happen at Field House it illustrates the importance of making sure people feel at ease about saying there is something wrong. Although the manager sent copies of the complaints procedure following the previous a small proportion of people who sent us survey forms indicated that they do not know how to make a complaint. The complaints log has been reorganised and a clear form introduced to record when a complaint is made. There had been one complaint since the previous inspection and this was well documented. The Home has started a rolling programme of training for staff about recognising signs of abuse and neglect and what to do if they suspect this. Eight staff attended a course in July, 10 more are booked to attend in August and a third session is planned for remaining staff. Worcestershire Council adult protection posters are displayed in the building as well as information about the statutory protection (the ‘Whistleblowing’ legislation) offered to staff who raise concerns in good faith. The full Worcestershire multi agency adult protection policy and procedures is not readily available to staff and there is no written practical guidance for staff about who to contact. The acting manager did adult protection training with Worcestershire Council in 2005. It would be beneficial for her to attend the current training with staff so that she is aware of the course content and can assure herself that it is compatible with the local multi agency policy and procedure. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ongoing upgrading of the premises, décor and furnishings is improving the level of comfort and safety for the people who live at Field House. EVIDENCE: People spoken to said they think the Home is clean and comfortable. The bedrooms we saw were clean, in a good state of repair and well furnished. Many bedrooms and some communal areas have been decorated and had new carpets and curtains. The service provider gave us a list of all the refurbishment of the building and replacement of furnishings since January which shows the considerable improvement that has been achieved. All parts of the building we saw during the inspection were clean and no poor infection control or hygiene issues were observed. The service providers are Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 21 having a new laundry built to replace the current unsatisfactory facilities; work has started on this but had been hampered by the weather conditions during July. Bedrooms are well individualised and people are encouraged to bring their own belongings with them to the Home. Several people told us how much they like their rooms, particularly those with views over the lovely gardens and surrounding countryside. Many of the rooms are very large and enable people to have living room furniture as well as a bedroom suite. The majority of bedrooms have ensuite facilities, including two rooms where new ensuites have recently been created using space created by taking an adjoining bedroom out of use. At the moment the Home does not have a strategy for helping people with dementia illnesses to find their way around the building. If the Home plans to continue to provide a service for people with dementia illness, this is something they need to develop with reference to available best practice guidelines. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has recognised the need to strengthen recruitment practice to reduce the possibility of unsuitable staff being employed. Staffing levels are not always high enough to give people at the Home enough time and attention but action is being taken to improve the situation. The service providers are investing in staff training so that people will be able to rely on the knowledge and skills of staff. EVIDENCE: Some staff have transferred to Field House from Broome House but no new staff have been employed since the last inspection. The manager is aware of the requirements for staff recruitment and confirmed that all necessary checks will be done for any new staff appointed. CRB checks have now been done for all overseas staff. The manager is going to review the reference request correspondence sent to referees to help her make sure references received are genuine. People told us the staff are generally very good. One person said that some staff are a bit too quick and another said a night carer has turned his call bell off and gone away without helping him. He had not told the manager about this but agreed to the inspector doing so. The manager said she would follow Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 23 this up. Some of the comments in the surveys also gave a mixed picture of what the staff are like and highlighted that there may be communication difficulties with some staff “ Some of the staff are very good others are not very good at all.” “ There are many foreign staff who have limited English and …… has difficulty sometimes in understanding them because of accent and a more limited vocabulary. …… feels that some procedures, such as washing, are done in a way she feels uncomfortable with. But she emphasises, others are lovely and helpful” Staff were very busy during the inspection. The rota shows that some days the Home is well staffed but on other days, staffing levels are lower. The manager said that there are days when it is hard to get cover, mainly due to holidays and sickness. This problem was made worse by a number of staff leaving during the period since the change of manager in January. The surveys received showed that people living at Field House do notice when less staff are on duty with only a third of the replies indicating that people feel staff are always available when they need them and the rest saying staff are usually available. One person commented – “At times it is clear there is a staff shortage” The service provider said that they are advertising for new staff at the moment to try to solve this. Since the previous inspection the manager has begun to address the serious shortfalls in staff training and a number of courses have been held. These have included courses in mandatory health and safety related topics, medication, adult protection and dementia. More courses are booked and more are planned. Considering that very few staff had had recent training in any topic when we inspected in January, a promising start has been made in improving the situation. For example in January only six staff had attended a recent fire lecture, this has increased to 22. Only six staff had up to date first aid training in January, now this figure is 16. There had been no training in dementia previously but 15 staff have now attended a one day course and another course is booked in August. It was encouraging to see that two of the cooks have recently completed an NVQ in professional cookery. There are also more staff now who have NVQ (six staff with NVQ 2, three with NVQ 3); this is partly due to the transfer of staff from Broome House. The manager has set up a system for keeping copies of course certificates and she has compiled a matrix to help her monitor progress towards all staff completing essential training. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 24 We interviewed the cook and activity organiser who appeared enthusiastic about helping standards at the Home to improve. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service are beginning to experience an improved service because the Home is being managed more effectively. EVIDENCE: A new manager started work at the Home in January and has implemented a range of changes that have improved the quality of the service as described throughout this report. The service providers have supported her in this. The Manager is still registered as manager in respect of The Coach House, the other service owned by Mr and Mrs Lane. This means that she is not deployed full time at either service. This will be something the CSCI registration team may wish to explore when dealing with her application for registration. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 26 A comprehensive quality assurance system is not fully established at Field House, for example people who live in the Home, their friends and relatives, staff and outside professionals are not routinely asked for their views in a structured way. Progress has been made though, for example the manager completed the Annual Quality Assurance Assessment document very thoroughly and the service providers have done a comprehensive review of the premises. Staff supervision has not been established but the manager has confirmed her intention to set this up during the next year. Health and safety in the Home has improved with more staff training and better attention to making sure storage of dangerous items like cleaning products is safe. Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 27 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 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 1 2 2 Field House Rest Home DS0000018505.V338795.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 9 Standard OP9 Regulation 13(2) Requirement You must ensure that safe systems are in place for the recording, storage, handling and administration of medication to make sure that people living at the Home always receive their medication safely. Timescale for action 31/08/07 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 You need to include more information in the statement of purpose and service user guide about the care that can be provided in the Home. If the Home is to continue to accommodate people with dementia type illnesses the way that this care will be provided needs to be described. A copy of the terms and conditions and the most recent report should be included in the service users guide, not just provided on request. You need to make sure that all people at the Home (or their relative or other relevant person) have received a statement of terms and DS0000018505.V338795.R01.S.doc Version 5.2 Page 29 2 OP1 Field House Rest Home 3 OP4 4 5 6 7 8 9 OP7 OP10 OP9 OP9 OP16 OP18 10 OP18 conditions. If a service for people with dementia type illnesses is going to be provided at Field House in the future you should investigate sources of information and guidance about recognised best practice in this area of care to enable you to develop the service. The assessment and care planning format needs to be reviewed to avoid duplicating information. You need to find out why some people living at the Home are not having all their personal care needs attended to and make sure that the reasons for this are addressed. It is recommended that you record when medication is given to people for self-administration to help you monitor that these are being taken safely. The date of opening of all medicine containers should be recorded and balances of medicines carried over so that medication can be audited. You should check that every person living at the Home (or their relative or advocate if this is appropriate) has received and understood the complaints procedure. The full Worcestershire multi agency adult protection policy and procedures needs to be readily available to staff together with practical written guidance for staff about who to contact. The acting manager needs to taken part in the adult protection training sessions so that she is aware of the course content and can assure herself that it is compatible with the multi agency policy and procedure. Field House Rest Home DS0000018505.V338795.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.V338795.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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