Inspection on 10/07/06 for Field View House

This inspection was carried out on 10th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 View House 26/11/08

Field View House 31/03/08

Field View House 27/09/05

Field View House 12/05/05

Field View House 25/01/05

Field View House 03/08/04

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 View House Sandheys The Slough Crabbs Cross Redditch Worcestershire B97 5JT Lead Inspector Sandra Wade Key Unannounced Inspection 10th July 2006 07:30 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 View House DS0000004234.V303002.R02.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 View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Field View House Address Sandheys The Slough Crabbs Cross Redditch Worcestershire B97 5JT 01527 550248 01527 403787 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 Arjan Bhoja Odedra Mrs Monica McGlynn Mrs Phyllis Wootton Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Manager must obtain a suitable management qualification (equivalent to NVQ 4) by 31st November 2006. 27th September 2005 Date of last inspection Brief Description of the Service: Field View House is registered for 20 older people requiring personal care. The home does not provide nursing care other than input available via the local community nursing teams. The home is set back off the main road between Studley and Redditch in a semi rural setting. Community facilities are available in both Studley and Redditch although the home is not on a bus route. The Home, which was formerly a domestic dwelling, has been refurbished and extended. Bedrooms occupy both the ground and first floor, most of which have en-suite facilities. A shaft lift provides users access to all parts of the home. The home has one large lounge and a separate dining room. Car parking is available at the front of the home. At the time of this inspection the fees ranged from £330.00 for a shared room to £375 for a single room with ensuite. Additional charges are made for chiropody and hairdressing. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Field View and consisted of a review of policies and procedures, discussions with the manager, staff and residents. This inspection took place between 7.30am and 6.30pm. Records examined included care plan files for residents, recruitment records, staff files, training records, social activity records, staffing records and medication records. Records relating to the care and services provided by the home were also viewed. During the inspection discussions were held with residents, visitors and staff to establish their views on care and service provided by the home. Comments are included within the report where appropriate. A pre-inspection questionnaire was received from the home on 31 May 2006, some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. On arrival to the home none of the residents were in the lounge. A member of staff said that residents were still in the process of getting up. What the service does well: Each resident receives a detailed assessment before they are admitted to the home so that the home know they can meet the needs of the resident. Throughout the inspection staff were observed to be caring and supportive to residents who reacted positively towards the staff. Staff were very co-operative during the inspection and were happy to provide any information requested of them. A visitor to the home confirmed that they had full confidence in the staff and one resident said that there are “friendly staff” in the home. One resident said that they liked it in the home and another resident said that the staff are “good”. Staff confirmed that they feel well supported by the manager and it was observed that staff worked well as a team in supporting the residents. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 6 One resident said that the food is “very good” and there is a choice. The manager had undertaken a survey with residents to ask about food and any negative responses had been followed up to ensure amendments to the menus could be made. What has improved since the last inspection? What they could do better: Information provided to residents prior to their admission is in need of updating so that residents can make informed judgements on whether to stay at the home. In addition, the manager needs to ensure that a letter is written to each resident following their initial assessment to confirm the home can meet their needs. Care plans are in need of review to ensure all care needs are documented as well as staff actions required to meet these needs. Records must show that the care needs of the residents are being met consistently. Some actions are required in regard to medication management to ensure records accurately reflect medications available and given. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 7 Actions are required to ensure the privacy and dignity of residents is maintained at all times. This in particular applies to how staff manage residents in communal areas. Further work is required in regard to the provision of social activities for residents to ensure they are consulted and have a choice in what they do each day. One resident said “not a lot goes on in the home” and they get “fed up” sometimes. Another resident said it would be nice to have some “entertainment after tea”. The complaints procedure does not contain all contact names, addresses and telephone numbers to ensure any person who wishes to raise a concern can do so easily by telephone or in writing. Although there have been some improvements in the décor of the home, there are still some areas requiring attention such as the bubbling flooring in the downstairs corridor and seating in the lounge. There is only one assisted bathroom in the home which places limitations on resident access. A review of assisted facilities is required to ensure there are sufficient numbers of accessible bathrooms available to residents. Hot water is not operating effectively in all rooms due to water pressure problems. This matter requires attention. Infection control and hygiene management in the home is in need of improvement. This in particular applies to the availability of hand washing and drying facilities to ensure residents are managed hygienically at all times. A review of staffing arrangements is required. A review of staff are working double shifts in one 24 hour period such as an early shift followed by a night shift is required. This is poor practice and could result in inconsistent care practices and overtiredness. Staff training needs to be further addressed to ensure there are sufficient numbers of staff with an NVQ II qualification in care as well as other training. This is to ensure the home can demonstrate competent staff are working in the home who can provide effective care to the residents. Criminal record checks must be in place for all staff. The Immediate Requirement Notice issued to the manager during the inspection is to be complied with. The manager must ensure that any risks associated with information provided on criminal record checks are considered and reviewed to safeguard residents. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 8 Some health and safety matters are in need review. This includes the use of door wedges, evidence of a gas safety check and appropriate food storage. 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 View House DS0000004234.V303002.R02.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 View House DS0000004234.V303002.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some of the information provided to residents is not fully up-to-date to enable residents to make informed choices about moving into the home. Residents are assessed prior to their admission to the home so that staff can be sure they can meet the resident’s needs. EVIDENCE: The manager advised that a copy of the Service User Guide is given out to residents when they are admitted to the home. During the tour of the home it was noted that a resident had one of these in their bedroom. Prospective residents can visit the home if they wish and request any additional information they may require about the home. One resident spoken to said that they could not remember if they had visited the home prior to being admitted. The Service User Guide should give up-to-date information about the home to enable residents to make informed choices about whether to stay at the home. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 11 The copy viewed in the home contained some out of date information which included an inspection report summary dated 2004 and details of fees charged up to April 2005. The manager agreed to update this. Residents are assessed prior to moving into the home so that their needs can be identified and the home can decide if they can meet the resident’s needs. Resident files did not contain copies of letters which confirmed the home could meet their needs following their assessment which the home are required to do as part of the care home regulations. Assessments viewed on files were not dated so that staff were clear when these needs were identified and when they would need to be reviewed. Field View House DS0000004234.V303002.R02.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 at least once during a 12 month period. 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. Residents needs are not clearly set out in care plans to ensure their health care needs are met and residents are not always being treated in a way that promotes dignity and respect. EVIDENCE: Staff were observed to be caring and supportive to residents throughout the inspection. Residents were mostly well presented and were observed to react positively to staff interactions. Care plan profiles were reviewed to confirm that the care needs of residents had been identified as well as staff actions required to meet these needs. A care plan profile for one resident confirmed their preferred daily routine including the time they wished to get up and dietary needs which included a high fibre diet. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 13 This resident was observed to have a bowl of cereal in the dining room at 9.35am. A nutritional assessment had been carried out which showed that the resident should be considered for food supplements, this was dated January 2006, this assessment also confirmed that that the resident should be referred to a Dietician. It was not evident that this had been done and there was no care plan in place showing how this residents nutritional needs should be met. The daily records showed that on occasions this resident did not eat well. The weight of this resident had been recorded up to 5.3.06 and seemed to be stable but there was no pattern as to how often this was being done. No weights had been monitored after this date despite it being evident the resident was not always eating well. During a conversation with this resident it was observed that this resident was frail and thin with dry skin that would bruise easily. Their cardigan was creased and they had a problem when speaking which was not reflected in their care plan notes. It was not clear if this problem had been followed up with the medical profession or if this was a permanent condition. Staff advised that this resident had skin wounds. The resident was noted to be receiving regular visits from a district nurse to attend to these wounds and a bath chart in the residents file indicated that the resident was unable to have a bath due to the dressings in place. The personal hygiene care plan consistently indicated “no change” and stated that the resident needed help every morning. It was not clear what this help was and what alternative method of bathing was required to attend to this residents personal hygiene needs. The resident said that they could not have a bath and staff therefore washed her in bed. She said that she was feeling “ok” and confirmed she received regular visits from the nurses. A skin assessment sheet was in the care plan file indicating that the resident was “high risk” and had broken skin but there was nothing written on the body chart indicating the location of the wounds so that staff could carry out any necessary monitoring of these and ensure the dressings remained in tact. This assessment was dated 15.9.06 which was not accurate. There was no care plan in place showing how the wounds to the skin were being managed or any staff interventions required between district nurse visits. The assessment carried out by Social Services confirmed the resident had some memory loss. Staff said that this resident seemed to “have their clock the wrong way round” as the resident was up all night and sleepy during the day. The daily records completed by staff showed that the resident frequently called out for staff during the night. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 14 This information was not reflected in any of the care plans in place and there were no staff actions indicated on how staff should manage this aspect of the residents care. Records confirmed that this resident had been seen by a Chiropodist in April 2006 and prior to this appointments had been indicated in 2005. It was not clear how often this resident was to be seen by the chiropodist. Records also indicated that the resident had seen an optician and that glasses had been provided. Although daily records had been completed, it was not evident that these are always linked to the care plans in place so that it is clear how staff have met the care needs identified. For example care plan records indicated that this residents dentures were to be cleaned each night but it was not clear from the daily records this was being done. A second care plan profile was reviewed. A hospital sheet on the care plan file stated that the resident was prone to falling and wandering around the home and had sustained a cut to their face. It also stated that the resident had a medical history of dementia. The social worker assessment confirmed that the resident was prone to wandering and would require supervision at all times. The falls risk assessment completed by the home stated that this resident was of “low risk” of falls which contradicted other information in the care plan profile. There was no care plan in place showing how staff should manage this person’s mobility and falls. There was also no care plan in place to show how this person’s memory loss and dementia should be managed. It was clear from the daily records in place that this resident was getting angry at staff on occasions and one entry stated the resident had a “fight” with another resident. As no care plan was in place in regards to this behaviour, there was no instructions for staff on how to manage this so that all staff could provide a consistent and effective approach. On speaking with this resident, it was clear that they did suffer from confusion but they did say they had “nothing to grumble about” in regards to their care. This resident was observed to be wearing a stained jumper. Assessment information stated that the resident wished to be bathed three times a week. The bath chart on this residents file showed that they were being bathed approximately once every eight or nine days which did not appear to be of their choosing. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 15 A skin risk assessment was available in this residents file but the body chart was blank and did not show the location of the injury to their face. The assessment had not been fully completed or updated so that staff knew to monitor and provide any care as required. There was no day to day care sheet on this persons file showing how they liked to spend their day and there were no care plans or care plan reviews evident to show how this persons care needs should be met. Although incidents had been recorded in the daily records such as wandering into other resident’s bedrooms and aggressive outbursts, it was not clear these had been followed up with action plans on how to deal with these. Care plan records confirmed this person did have access to specialist support such as the doctor, chiropodist and optician. It was not clear how often chiropody support would be required. A review of medications was undertaken. These are stored in a medication trolley in a locked location. The blister pack system is in use which staff confirmed was effective in managing the medications. On the whole medication management was found to be satisfactory. Some areas of improvement were noted. For one resident Co-proxaolan was written on the MAR but Co-codamol was actually being given, the manager confirmed this. Medications indicated on the Medication Administration Records (MARs) must be accurate and correspond with what is actually being given otherwise this could result in medication errors. Prochlorprazine 5mg which was to be given three times a day had been crossed of the MAR and changed to once a day. This handwritten change was not dated or signed to confirm this was on the instruction of the GP. There were insufficient tablets in the bottle for the prescribing period and the manager explained that the doctor was stopping these after the two tablets had gone. Tablets left over in bottles from the previous prescribing period had not been carried forward onto the new prescribing period so that staff were clear how many tablets/capsules they had started with and could effective audit the medications. Fridge temperatures had been recorded but these should be recorded with a thermometer that indicates the minimum and maximum temperatures. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 16 Some residents were taking homely remedies such as cough mixture and vitamin tablets. A homely remedies policy was available to show how these should be stored but it was not clear that these medications should be checked with the GP to ensure they had no adverse reaction with other medications being given. The manager said these were always checked with the GP but she would ensure the policy reflected this. In regard to the privacy and dignity of residents it was observed that there are some issues which require attention. One member of staff was overheard to ask residents about which toilet they would like to use and comments were overheard such as “you needed that”, “don’t wet yourself” or “don’t lock the door” which all impact on the privacy and dignity of the resident. Some of the toilets in the home do not lock preventing residents from having the option to lock the door to maintain their privacy if they wish. No napkins or serviettes were provided at breakfast resulting in residents having to ask for tissues. A member of staff offered the inspector a resident’s room to hold a discussion with a resident who had their own room elsewhere in the building. Personal residents rooms should not be used for other purposes such as this as it is the resident’s private room. One resident said that staff did not knock their door when entering but another resident said that staff do knock their door and are respectful towards them. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 17 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents find that the lifestyle in the home matches their expectations although overall they are happy in the home. Residents sometimes have choices in how their care and services are delivered but this is not the case all of the time to help residents feel that they have some control over their lives. EVIDENCE: Activities are provided in the home but there is no planned activity schedule. A record is kept of activities provided and records seen confirmed the following:- bingo, keyboard player, singer with exercise, exercise ball, eye spy, skittles, manicures, library and fashion and fun. It was not clear which residents had participated in these activities or that residents had been consulted about activities so that staff knew the residents liked what was being provided. The manager said that outdoor trips are arranged when the weather is good. One resident said that “not a lot goes on in the home” and they get “fed up”. Another resident said there was not much going on in the home and they get bored. This person said it would be nice to have some entertainment after tea. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 18 Residents are able to maintain contact with family and friends and visitors were seen in the home on the day of inspection. One visitor said that their relative didn’t participate much in the activities provided. Residents are being given some choices in how their care is managed such as times they get up and go to bed but in other respects their choices are limited. A resident who indicated they would like to be bathed three times a week was being bathed every 8 or 9 days demonstrating this residents choices were not being respected. Staff were heard to ask residents if they wanted a cup of tea as opposed to giving them a list of choices in drinks they could have. One resident was asked if they wanted toast and marmalade for breakfast as opposed to them being given a full choice of what was on offer. The manager said that staff tend to know what each residents likes and dislikes are and one particular resident has toast and marmalade every day despite having being asked on numerous occasions if they wish to have something else. A member of staff was observed to take a knife and folk off a resident to cut up their food without asking. One resident said that the food was “alright” and they had two choices of meals sometimes, another resident said that choices of meals were offered and there was a good choice of drinks available. One resident said that there was never enough meat at mealtimes and they had reported this to staff and they were getting a bit more. Menus in the home show that every day cereal, toast, tea or coffee is available at breakfast time. No cooked choices are detailed and no other drinks are listed. The manager said that usually once a week the residents had a hot choice and although the cook started at 9am usually the night staff would provide breakfast for any residents that were up early. The lunchtime menus did not show that two choices are being given consistently. At teatime mixed sandwiches are offered every day with one other option such as soup or pizza, cheese on toast or beans on toast. The manager said that the cook prepares the sandwiches before she leaves at 1pm. The menus do not show that a supper menu is offered to residents to help maintain good nutrition and ensure the gap between teatime and breakfast time is not too long. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 19 At lunch time residents had salmon or quiche with salad, potatoes and pork pie. A member of staff was walking around with a bottle of salad cream and a spoon asking residents who wanted salad cream as opposed to this being available on the tables for them to independently help themselves. Salt and pepper was on the table and residents were drinking squash, water and one person had lager. One resident had her food in a dish, staff said was how the resident preferred their meal to be served. Staff were around to offer any assistance required and residents were not rushed. During the tour of the home it was found that the UHT skimmed milk was being used as opposed to fresh, semi skimmed or full fat milk which can be beneficial in maintaining good nutrition for some residents. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 20 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to allow complaints and allegations of abuse to be received and appropriately investigated so that residents in the home are safeguarded and protected. EVIDENCE: A complaints procedure is in place but this does not detail full contact names, addresses and telephone numbers should a visitor or relative wish to take a copy of this away to put a complaint in writing. The home has not received any complaints since the last inspection and no complaints have been received by the Commission. The manager has a logbook in place to detail any complaints received. A policy and procedure on the prevention of abuse is available in the home and some staff have undertaken video training so that they know how to recognise this. The training schedule provided by the manager shows that there are still some staff who need to complete this training. The reporting procedure is on display in the deputy manager’s office should an allegation of abuse be received by the home so that staff know who they need to contact. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 21 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, 21, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not have full access to bathroom facilities and the management of infection control is in need of improvement to ensure poor practice does not impact on resident health. EVIDENCE: This home has a lounge, dining room, two bathrooms (one assisted) and one cubicle shower. There are 15 single bedrooms and two double rooms and all but two rooms have an ensuite facility. A new laminate floor has been laid to the entrance of the home and since the last inspection various areas around the home have been painted and decorated. On viewing the lounge it was observed that many of the seat covers do not fit the cushions on the chairs and some of the chair arms were frayed and worn. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 22 Blankets on chairs, which were being used by residents, were stained and the wooden legs on some of the red sofas were chipped. There were three small tables for all residents to use for drinks etc. Since the last inspection new wooden ‘Aqua grip’ vinyl wooden flooring has been laid in the main corridor and dining area. It was noted during the tour of the home that the flooring in the corridor near to room 8 had ‘bubbles’ in it which could cause residents to trip over it and therefore requires attention. Three bedrooms had been redecorated and recarpeted since the last inspection with matching curtains and bed lines. Other bedrooms seen were clean and tidy with the exception of one room which had a stained carpet. One resident said they had a “lovely room” and they were “very happy with it”. The call bell lead was missing from the socket in one room and in another room the floor to the ensuite was very wet suggesting there was a leak, a cloth that had been placed on the pipe was very wet. The manager said that this had been brought to her attention and action was in hand to address this. In one bedroom there was no bedside lamp or lockable facility for the person to keep any personal possessions. The manager said that the resident did not want a lamp. Clothes in the drawers were stained and it was noted that some items of clothing were not labelled to ensure they would be returned from the laundry. The manager said that this particular resident had limited clothes and they were reluctant to remove any clothes from the drawers until they had the opportunity to discuss the matter with the resident’s family. It was found that some of the rooms did not have storage facilities for toiletries in the ensuite and in one room there were no towels. Some of the towels looked worn and in need of replacement. The manager acknowledged that more needed to be purchased. The garden has a patio area but the grassed area has to be accessed by steps which would restrict those residents with mobility difficulties from being able to use this area. At the time of this inspection only one of the bathrooms was being used, the upstairs shower room and bathroom, both of which do not have assisted facilities, were being used as storage areas. As only one bathroom is in use this restricts usage and could present a problem if the bathroom is in use when it is needed for use by another resident. As the shower is of the cubicle type it would be difficult for residents to have the option to use the shower as there would be insufficient space for staff to give assistance. The manager said that they usually do five baths a day using the main bathroom and if another resident needs assistance while the bath is in use they will use the large toilet and wash basin. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 23 The assisted bathroom when viewed contained a hoist, large exercise ball and there were several units on the floor waiting to be fitted making the environment look untidy. The manager said they were awaiting a plumber to fit the units. Toiletries were found with names on in the cupboards in the bathroom, these should be stored in resident’s bedrooms to prevent communal use. Two of the toilets did not have any toilet roll and one of these had a broken toilet roll holder. Water temperatures tested in bedrooms were found to be within safe levels so that they would not scald residents. Some of the taps did not work effectively due to water pressure problems. In two rooms when the tap was run there was a very loud vibrating noise which shook the hand wash sink which would not be pleasant for the residents using these rooms. In one room the hot water went off completely as soon as the hot water had started to run hot. It was found during the tour of the home that there are restricted facilities for staff to wash and dry their hands. Liquid soap and paper towels should be made available in communal toilets and bathrooms to promote good infection control practice and maintain hygiene. A commode in one of the rooms was dirty and in one bedroom a used face flannel on one of the wash-hand basins had an unpleasant odour. There are no suitable facilities available in the home for the cleaning of commode pots and the inspector was informed that these are currently being cleaned in the upstairs bathroom which is not appropriate. This bathroom was noted to contain a small hand wash sink only. Sluicing should be carried out in a dedicated area and specific procedures for cleaning should be followed which do not impact on the use of resident bathrooms. The laundry area is small and does not have a hand wash sink for staff to wash their hands. There were no gloves or aprons in the laundry for staff to maintain good infection control procedures. The manager said that staff carry gloves on their person. It was not evident that the home has been inspected to confirm compliance with the Water Supply (Water Fittings) Regulations 1999. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in the outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all staff have completed the necessary training to ensure residents are in safe hands at all times and the safety of residents is not fully supported by the homes recruitment practices. EVIDENCE: At the time of this inspection there were 18 residents in the home. The home is supported by a manager and deputy manager who cover the home between them seven days a week. The manager said that they aim to have three carers on duty during the day and two waking night staff. The manager works in addition to these hours and duty rotas show that the manager works 6 days a week. In addition to this staffing arrangement there is one cook who does the catering from 9am – 1pm seven days a week and a housekeeper who works from 9.30am – 1.30pm five days a week. Carers will do any cleaning tasks required on the two days a week when the cleaner is not in the home and also do the laundry and prepare any additional items needed at teatime. Completing these tasks takes carers away from their caring duties and duty rotas do not show the amount of time carers are allocate to do these duties. . Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 25 The manager said that she felt the staffing for the home was adequate. One carer said “I love it here” and confirmed they were well supported by the manager. Another carer said that they did manage to do all the jobs that were expected of them. A visitor to the home said that they had full confidence in the staff. One resident said that they had no complaints about the staff, one resident said that she could always get hold of a member of staff if she needed to and staff were “friendly”, another resident said that staff were “very good”. On viewing duty rotas it was noted that the full names of staff are not indicated so that there is a clear audit trail. Some staff are working day and night shifts in close proximity to one another and some are working a 3pm – 10pm day shift followed by a 10pm to 8am night shift. This is poor practice and these shift patterns contravene the Working Time Directive which states there should be an 11 hour break between shifts. It is likely that some staff would find it difficult to remain effective working these long hours. Duty rotas also do not state the night shift hours. Duty rotas show that there are 9 senior carers working in the home and it was established from discussions with the manager that only two of these have attained a National Vocational Qualification (NVQ) II in Care. Staff working in a senior capacity should have a minimum of an NVQ II as well as experience to demonstrate they are both qualified and competent to work in this capacity. The manager is aware that 50 of the care staff should have attained an NVQ II qualification in care by 2005 to demonstrate that staff are suitably trained and effective in their role. Of the 15 care staff in post, two have completed this and two are currently undertaking the training. Other training is taking place such as first aid, moving and handling, fire, medication and food hygiene. Some staff are still to complete some of this training. The manager uses videos to provide this training and staff are required to complete a questionnaire to demonstrate their understanding of the training provided. One new member of staff spoken to said they had completed an induction to the home plus all statutory training. The induction training package was viewed and this was noted to be comprehensive but discussions with the manager confirmed that not all staff who should have completed this have done so. Recruitment procedures for staff were reviewed. A file for a new staff member was viewed to confirm recruitment procedures carried out. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 26 Several of the documents were not dated and a gap in employment had not been explained. One of the references was dated after the date of commencement of the member of staff. The manager is aware that all recruitment information must be obtained before a member of staff works with in the home to safeguard residents. Criminal record bureau checks were requested for all staff and it was found that checks had not been obtained for all staff working in the home. Some were copies of checks staff had obtained when working for other homes. Some of the information detailed within these checks did not appear to have been explored with the members of staff concerned or acted upon appropriately. An Immediate Requirement Notice was issued to the manager to pursue these matters and to assess any risks to residents. The manager was requested to forward an action plan to the Commission stating actions taken. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 27 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, 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. Systems are in place to allow residents to comment on how the home is managed so that they feel valued and supported but there are some issues relating to health and safety that need to be addressed to ensure the residents are fully safeguarded. EVIDENCE: The manager has worked in the home for three years and has been the Registered with the Commission for approximately 12 months. The manager is working towards achieving the Registered Managers Award by November 2006 and has undertaken other training to update her knowledge and skills. Staff said that they felt supported by the manager and residents were positive in regard to their comments on staff working in the home. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 28 A visitor to the home said that staff were supportive and caring and any requests made of them were carried out. The manager said that resident meetings take place approximately two monthly but the notes of these meetings were not available in the home to confirm this. A questionnaire had been sent to residents asking their views on several issues linked to the management of the home. The questionnaire seen asked questions on meal times, communication, the home and care. The results of these surveys had been summarised in a report and actions had been detailed in response to the issues raised. Actions included speaking with one resident about their likes and dislikes in regard to the food provided. Re-emphasizing to residents that they can ask a member of staff at any time for food or drinks. Some residents had voiced that they did not wish to be disturbed at night during the night checks and this was acknowledged. Some residents could not sleep at night due to being disturbed by another resident. This resident has since left the home. A review of resident pocket monies was undertaken and it was found that records and monies available were accurate. Appropriate storage facilities are in place to ensure any money can be kept secure and receipts are obtained for any transactions undertaken on behalf of residents. Staff formal supervision is being carried out and records were in place to confirm this. The manager is aware that all staff must receive this six times a year. The pre-inspection questionnaire received from the home confirmed that health and safety checks are being carried out including fire equipment in January 2006, a five year electrical wiring check in 2004 and checks on the bath, lift and hoists in January 2006. A fire report for the home confirmed the home was satisfactory. The last gas safety check was in May 2005 and is now overdue. Electrical portable appliances were due to be checked and the manager advised that the proprietor would be doing this. Door wedges were in use in the home which do not meet with the fire precautions. If doors are to be kept open then suitable devices linked to the fire alarm must be used so that the doors release in the event of a fire. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 29 Some staff were not wearing appropriate footwear to support the moving and handling of residents which could result in the risk of injury to the resident or member of staff. Accidents in the home are being reported in the homes accident book but it was found these are not being reported to the Commission as required. The manager agreed to do this so that the Commission can monitor these and ensure appropriate action is being carried out by the home following accidents. Storage facilities in the home are limited for staff and there are no facilities for staff to change. The home are required to make this provision available to staff. During the early morning, the kitchen was viewed. It was found that tinned fish in the fridge that had been opened was not labelled or dated so that staff knew when this needed to be used or disposed of. A dish in the fridge with foil on the top had been labelled but not dated. A meal in the mini cooker with foil on the top was not labelled or dated. Two quiches had been taken out of the freezer to defrost but they were warm to the touch suggesting they had been out for some time and needed to be stored in the fridge. A packet of flour had been opened but had not been transferred to a sealed container to ensure this was pest proof. The microwave was food splattered and in need of cleaning. Eggs were not stored in the fridge which is recommended. The freezer was in need of defrosting. There was a limited supply of food in the food store, the manager advised that the home received a delivery each Tuesday and were due for a delivery the day after the inspection. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 30 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 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X X 2 1 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 3 X 3 3 2 2 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 31 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. 2. Standard OP1 OP4 Regulation 5(1) 14(1)(d) Requirement The Service User Guide must be updated. The manager must ensure that following the assessment of a resident, a letter is written to confirm the home can meet their needs. The registered person must ensure that individual care plans are brought up to date and accurately reflect the condition and needs of the resident. (Outstanding from September 05) Care plans must detail staff actions required to meet care needs and demonstrate that these actions are being carried out. Risk assessments must be fully completed and actions indicated carried out. Timescale for action 31/10/06 30/09/06 3. OP7 15 31/08/06 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 32 4. OP8 15 The manager must ensure that individuals healthcare needs are recorded in their care plans (Outstanding from September 05 inspection) Medication must be managed effectively in the home. The Medication Administration Records (MARs) must accurately reflect the number of tablets/capsules available at the beginning of each prescribing period. The MAR must accurately reflect the medications being given to the resident. 31/08/06 5. OP9 13,17 31/08/06 6. OP10 12 Any handwritten entries on the MAR must be dated and signed to that there is an audit trail. The registered person must 31/08/06 ensure that the privacy and dignity of residents is maintained at all times. This in particular applies to how staff manage residents in communal areas and ensuring the bedrooms of residents are for their private use only. Locks to all toilet and bathroom doors are to be made available as appropriate. The manager must ensure residents are consulted on the provision of local, social and community activities and implement a programme of activities based on their choices and preferences. 7. OP12 12 30/09/06 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 33 8. OP14 12 9. OP15 12 The manager must ensure the home is conducted in a way, which maximises the resident’s capacity to exercise their autonomy and choice in how their care and services are delivered. The manager must be able to demonstrate that on a consistent basis, the home provide adequate quantities of suitable, wholesome and nutritious food which is varied and available at such time as may reasonably be required by service users. In this regulation “food” includes drink. 30/09/06 31/10/06 10. OP16 22 11. 12. OP18 OP19 13 23, 13 Menus are to be reviewed to show details of all meals, drinks and snack meals provided. (Information detailed in Standard 15 should be used as guidance) The manager is to review the 30/09/06 complaints procedure to ensure this clearly details names, contact telephone numbers and addresses so that complainants have all the information they would need to make a complaint. The manager is to confirm when 31/10/06 all staff have completed training on abuse. The manager is to devise an 30/09/06 action plan to address décor issues as identified in the body of this report. This includes a prompt date to address the bubbling floor surface in the corridor and the worn lounge furniture. Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 34 13. OP21 23 There must be sufficient bathing facilities available for residents to use. A review of assisted facilities available to residents is to be undertaken. Broken toilet roll holders are to be replaced and toilet roll made available in all toilets. The manager is to provide an action plan with dates for the above to be addressed. The Registered Provider is to take action to ensure hot water is operating effectively in all areas of the home. The registered manager must ensure that effective measures are in place to control the risk of infection. An action plan is to be forwarded to the Commission showing how the following is to be addressed: Suitable facilities must be available for staff to wash and dry their hands. This includes the laundry area. Paper towel and soap dispensers must be available in identified communal toilet and bathroom areas where staff and residents would be expected to wash and dry their hands to maintain standards of hygiene. (Outstanding from September 05 inspection). Suitable facilities must be available in the home for sluicing. 31/10/06 14. OP25 23(1) (2) 31/10/06 15. OP26 13,16 30/09/06 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 35 Gloves and aprons must be available for use in the laundry consistently. Action is to be taken to confirm the home is operating in compliance with the Water Supply (Water Fittings) Regulations 1999. The manager is to review 31/10/06 staffing arrangements with the home to prevent staff from working double shifts such as a day shift followed by a night shift which can contravene the Working Time Directive. Duty rotas must demonstrate care staff hours allocated to noncaring duties such as cleaning, laundry and catering so that the number of hours being provided for both care and domestic services can be confirmed as sufficient. The night shift hours must be indicated on the rota and surnames of staff are to be added to ensure there is an effective audit trail. The manager must be able to demonstrate that there are sufficient numbers of competent and qualified staff working in the home. The manager is to forward an action plan showing how the home propose to meet the standard of 50 of care staff to achieve a NVQ II qualification promptly. 16. OP27 17,18 17. OP28 18 30/09/06 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 36 18. OP29 7,9,19 Sch2 The manager is to address the Immediate Requirement Notice issued in regard to criminal record checks and recruitment procedures. A copy of the audit undertaken on all staff files is to be forwarded to the Commission detailing any omissions in information available and actions proposed to address these where applicable (by 31/08/06). Details of CRB checks obtained must be detailed including dates received and dates these have been applied for (by 31/08/06). The manager is to devise an updated training schedule, which clearly shows training completed for all staff. The registered person must ensure that all accidents are reported to the Commission. Record and record keeping must be addressed as detailed within this report. The home must be conducted to ensure the health, safety and welfare of the residents. A review of health and safety matters as detailed in the body of this report is to be carried out. This includes:Appropriate storage of food The completion of an updated gas safety check. A review in the use of door wedges. 15/07/06 19. OP30 12,18 31/10/06 20. OP37 12 30/09/06 21. OP38 13 31/08/06 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 37 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 OP27 Good Practice Recommendations The manager is advised to review recruitment procedures in regard to senior carers. The manager should ensure that the experience, competency and qualifications of senior carers can be demonstrated. It is advised that the manager review the staffing arrangements in the home in regard to long shifts and split shifts which is poor practice. 2 OP27 Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Field View House DS0000004234.V303002.R02.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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