Inspection on 31/03/08 for Field View House

This inspection was carried out on 31st March 2008.

CSCI found this care home to be providing an Adequate service.

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 View House 26/11/08

Field View House 10/07/06

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 Deborah Shelton Unannounced Inspection 31 March 2008 10:45 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.V357381.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 View House DS0000004234.V357381.R01.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.V357381.R01.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. 10th July 2006 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 £380.00 for a shared room to £450 for a single room with ensuite. Additional charges are made for chiropody, hairdressing, personal items and toiletries. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and obtaining their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The following information in this report is the findings of an unannounced inspection visit that took place on Monday 31 March 2008. Seventeen people were living at Fieldview House at the time of the visit. Two residents were ‘case tracked’, this involves finding out about their experience of living in the care home by meeting with them, or observing them, talking to them and their families (where possible). Looking at their care files and the environment in which they live. Staff training records are reviewed to ensure training is provided to meet resident’s needs. Documentation regarding staffing, health and safety, medication and complaints are also reviewed. During the inspection, the acting manager was on duty along with three senior care assistants, the cook and a domestic. The registered owner also attended. The inspection process consisted of a review of policies and procedures, discussions with the acting manager, staff and residents. Other records examined during this inspection included, care, staff recruitment, training, staff duty rotas, health and safety and medication records. Notification of incidents received by us from the Home and any other information received were also examined. The inspection process enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. The inspector was introduced to a majority of the people that live at Field view House and conversations were held with seven people. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff. The inspector wishes to thank the manager and staff for the hospitality on the day of inspection. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The acting manager has worked hard to address all of the issues identified at the last inspection and has shown that she understands and is willing to undertake the action to address issues identified at this inspection. Improvements have been made to pre-admission processes. All documentation seen was signed and dated by the person recording the information. A letter is written to prospective residents to confirm that the Home would be able to meet their needs and offering them a place. Preadmission processes are now robust and sufficient information about the Home is given to residents to enable them to make an informed choice about moving into the Home. A lot of work has been completed regarding care planning. Those seen contained sufficient information to enable staff to meet the identified care Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 7 needs of individuals. Care plans were up to date, detailed and easy to understand. Some issues were identified which were discussed with the acting manager on the day of the inspection. Medication practices and systems have improved, medications are checked upon receipt at the Home. Audits take place on a monthly basis to check stock against records held. Apart from medications to be returned to the pharmacy storage was satisfactory. During this inspection privacy and dignity of residents was maintained and staff treated those under their care with respect. Residents were complimentary about staff and the care they receive. Those residents spoken to confirmed that there had been improvements in the meals provided at the Home recently. Residents were seen given a choice and alternatives to those choices were provided. Menus in place demonstrate that residents receive a wholesome nutritious diet on a daily basis. A number of staff have undertaken adult protection training, the manager is aware of the staff that still require this training and has arranged training for these staff. New furniture has been purchased for the lounge area and a hand wash sink for the laundry. The Home was clean and hygienic and gave a welcoming and homely feel. Changes have been made to duty rotas, which now clearly identify the full name of the staff member on duty. Staff no longer work long or double shifts due to staff shortages. This ensures that staff are not too tired to perform their job to a satisfactory standard. Staff files seen contained copies of criminal records bureau checks and the acting manager confirmed that these checks have been undertaken for all staff employed and the volunteers that visit the Home. A training schedule has been devised which clearly records the name of the staff member with the training required. However, this document did not record the date on which the training had been arranged. Health and safety issues identified at the last inspection have been addressed. Fire doors were not wedged open during this inspection. Appropriate, up to date documentation was in place to demonstrate that safety checks are undertaken on a timely basis. What they could do better: Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 8 Improvements were noted to care plan documentation, however further information is to be recorded to ensure that health care needs are not missed. It was noted that one resident was losing weight. This resident had been prescribed a nutritional supplement. There was no documentary evidence to demonstrate this in the care file or on the medication administration records. There was no details of the action to take to reduce the risk of further weight loss i.e. use of cream instead of milk in cooking, use of higher calorie alternatives when preparing meals. The Home’s documentation stated that this resident should be referred to a dietician but there was no documentary evidence to demonstrate that this had taken place. Information recorded in the care file regarding a pressure area was also insufficient. It was noted that this resident is under the care of the District Nurse regarding the pressure area but the action that staff are to take between visits from the District Nurse are not recorded. It was noted that monthly audits take place regarding medication available. An audit undertaken on the day of inspection identified three errors each relating to the stock of medication available, which did not balance with records held. Staff spoken to said that it would be possible to make errors with record keeping as they often get distracted when administering medication before they are able to write medication records. Enabling staff to move the medication trolley out of the medication storage room may make medication administration procedures easier for staff. When talking to residents all where highly complimentary about the staff, management, food and care but did not feel that the activities provided met their needs. Residents said that they sometimes get bored. Some residents said that they had enjoyed the trip out for a meal recently and would like the opportunity to have more regular trips out of the Home. Records held to demonstrate what activities have taken place have improved since the last inspection. The method of cleaning commodes may produce a risk of cross infection and the acting manager was advised to discuss this with an infection control specialist. This will ensure that the methods in use are the best for the Home with the least risk of cross infection. The Home provides a varied range of training opportunities, however all staff must undertake mandatory training on a regular basis. This ensures that working practices are safe for residents and for staff. Induction training in line with skills for care requirements does not take place currently. The acting manager said that a majority of staff recently employed had already achieved a national vocational qualification in care at level 2 and therefore did not need to undertake this training. Systems must be in place to ensure that staff employed who do not have this qualification receive induction training in line with the national training organisation’s requirements. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 9 An error was noted when checking resident’s spending money records. There was no documentary evidence to demonstrate that a small amount of change from a purchase had been returned to a resident’s account. From discussions with the manager it was noted that receipts are not always obtained for confectionary as the shop does not always provide one. The acting manager acted quickly to ensure that all staff request receipts for every item purchased, include low cost items. An audit of resident’s funds was immediately undertaken and funds balanced with receipts and spending money records. 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 View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 10 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.V357381.R01.S.doc Version 5.2 Page 11 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 and 3 Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed. This ensures that the Home can meet the individuals identified needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users guide was reviewed but not in detail. Information from the last satisfaction survey was contained within the guide and showed in an easy to read format the findings and action taken to address issues. Copies of the Service User’s Guide were seen in resident’s bedrooms. This ensures that residents have information about what life is like at Field view House. The care file of one of the residents most recently admitted was reviewed to evidence whether appropriate pre-admission assessments are undertaken. A discussion was held with this person regarding the pre-admission process. It was noted that a relative had looked around the Home and had all of the information needed to help him decide that Field view House was the best Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 12 place for his loved one. The resident confirmed that they had settled well into the Home and staff were friendly and caring. Standardised pre-admission documentation is in use. The documentation contains sections to enable an assessment of individual needs and abilities to take place. Relevant information regarding issues such as sight, hearing, appetite, continence, and medication amongst other things is obtained. Records provided a clear picture of the needs of the prospective resident. Sufficient information was recorded to enable staff to meet the health, social and personal care needs of this person. Care plans are developed upon admission to the Home with the information obtained during the pre-admission process. Two issues were identified at the last inspection regarding pre-admission processes. Information was not dated and signed by the person completing the details and the Home did not confirm in writing that they were able to meet identified needs. Both of these issues have now been addressed. All information was dated and signed in the file seen and letters are sent after the assessment to confirm that a place is available and stating that the Home would be able to meet the needs of the potential resident. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 13 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 Shortfalls in the information recorded in some care files means that healthcare needs may be missed. Residents have good access to a wide range of health professionals which results in their healthcare needs being met and are treated with respect and their rights to privacy and dignity are maintained. Systems and practices regarding storage and administration of medicine have improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of two residents identified for case tracking were reviewed. Conversations were held with both residents to find out their views of life at Field view House. Each person had a care file which contained relevant risk assessments, care plans and daily records. Appropriate equipment was provided for the residents Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 14 whose care plans were reviewed, for example walking frames, nursing beds and pressure relieving mattresses as necessary. Both files contained tissue viability risk assessments. These determine the risk of a resident developing a pressure area. One resident was at a low risk and the other a high risk. However, both assessments were being reviewed every three months. It would therefore appear that the action to take regarding the risk assessment is the same whether the person is assessed as high or low risk. Residents at a high risk of developing a sore should have their risk assessment reviewed more regularly to enable staff to identify any changes in circumstances which may require more immediate action. The acting manager confirmed that action would take place immediately to change the timescales for reviewing those at high risk. The resident with a low risk had developed a small pressure area, which was being attended to by the District Nurse. Staff should record in detail the action to be taken regarding the pressure area and the advice given by the District Nurse when she visits. One nutritional risk assessment highlighted that the resident should be referred to a dietician (according to the Home’s risk scoring system). There was no evidence in the care file that this had been done. The acting manager stated that a conversation had been held with the GP regarding this person’s weight loss and nutritional supplements (fortisips) had been prescribed. There was no documentary evidence in the care file to demonstrate that this person had seen the GP regarding weight loss or that fortisips had been prescribed. Nutritional intake records did not state in detail the amount of food eaten, for example staff record “… has eaten well”. Weight records demonstrate that this person has lost 1st 4llb in one year. The acting manager was aware of this and confirmed that the weight loss is a part of the resident’s medical condition. The care plan did not record that weight loss was to be expected or the action that is to be taken to reduce the weight loss. More detailed records are to be kept of nutritional intake, including the times when nutritional supplements are taken. These details were not recorded in the care file seen. Confirmation was received in writing following the inspection that weight charts have been amended to clearly show any fluctuation in a resident’s weight over a twelvemonth period and specific monitoring charts have been implemented to record food intake. This will enable the Home to monitor food intake and subsequent weight loss or gain more effectively. A bath monitoring sheet in one care file had only been completed up until September 2007. The acting manager confirmed that the method of undertaking personal hygiene for this resident had changed due to changes in the resident’s wishes and in health. Strip washes now take place instead of baths. Records should be available to demonstrate how personal hygiene needs are being met. Following the inspection the acting manager confirmed Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 15 in writing that bath monitoring sheets now document whether a resident has had a wash/strip wash or bath/shower. Daily entries in care files were sometimes brief and not linked to care plan needs. They did not always give a clear picture of changes in a person’s health or wellbeing. For example occasionally all that was written was “… is fine, ate well…”. The inspector was introduced to a majority of residents and had fuller conversations with seven people. All felt that their health care needs were being met. Some commented that they “see the GP whenever they need to”. Residents said that staff were attentive to their needs. One of the residents being case tracked confirmed that staff are very good at contacting the GP, District Nurse, Chiropodist etc as needed. Records in the care file showed when this resident had been visited by these professionals and the action that they had taken. The care files seen contained up to date, relevant information regarding care needs and the actions that staff are to take to meet these needs. Comprehensive details are recorded regarding personal hygiene, daily dressing bathing, nail care, hair care, evening routines etc. Information is recorded in accordance with the details obtained during the pre-admission assessment. A lot of information is recorded regarding preferred routines and likes and dislikes. Care plans had been reviewed on a monthly basis and updated as necessary. Care plans had been signed on the date that they were implemented to confirm agreement to the planned care. The acting manager was advised that, whilst there has been much improvement to the care plans in place, more information should be recorded in some areas i.e. tissue viability to record the action that staff are to take between District Nurse visits. The medication records for the two resident’s being case tracked were reviewed. Medication is stored in a locked medication trolley that is secured to the wall. Staff are not able to remove the trolley from the medication room. Staff said that they would prefer to take the trolley out of the room. Currently they dispense the medication in the room and take it individually to residents, this can be time consuming and confusing if residents ask for assistance whilst they are walking back to the medication room to complete medication administration records. A controlled drugs cabinet is in place but currently not in use as there are no controlled drugs on the premises. Keys to the medication room and trolley are in the possession of the senior member of staff on duty at all times and handed over at the end of the shift to the next senior on duty. A lockable medication fridge is available and temperatures are recorded on a daily basis. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 16 The medication room was warm but the temperature of this room is not recorded. Medications should be stored below 250C in order to comply with their product licence. There was no evidence that storage is below this temperature. Copies of prescriptions are kept on file and medication received is checked against the medication administration record and the prescription. Returned medications are kept in the cupboard used to store medications in use. The staff member spoken to was advised that medication to be returned should be stored separately in a locked cupboard in a locked room. Details of the medications to be returned are recorded in a “returns book”, this is checked and signed by the pharmacist before they remove the returned medication from the Home. Only senior staff are responsible for administering medication. No medication is currently administered after 9pm. One resident self-administers his medication and a risk assessment is in place regarding this. The risk assessment is reviewed on a monthly basis. Staff also count his tablets on a daily basis to ensure that the resident has taken the required medication. This check is recorded in a book. Medications available for the two resident’s case tracked were checked against their medication administration records. Three errors were identified. The stock of paracetamol for one resident did not balance with the medication administration record. Two other medications had one tablet more than should have been available. This means that these tablets had been signed for as being given but had not. There is a homely remedies policy in place, however this has not been agreed with or signed by the GPs who visit Field view House. Homely remedies must be checked with the GP to ensure that they are safe to take along with the resident’s existing medication. Improvements were noted in medication management and a senior member of staff has taken responsibility for receipt, disposal and auditing of medication. A medication audit takes place on a monthly basis. Following the inspection visit the acting manager confirmed in writing that medication audits would now take place on a fortnightly basis until issues identified during the inspection have been resolved. Copies of the medication audits undertaken two days after the inspection were forwarded for review. Staff appeared to have a good relationship with those under their care. Staff respected resident’s privacy and dignity and were kind and patient throughout the inspection. Residents were dressed appropriately for the time of year. Those spoken to were well groomed with nicely brushed hair and ladies had manicured nails with polish on if they wished. Field View House DS0000004234.V357381.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. People who live at Field view House are encouraged to keep in contact with family and friends. The lifestyle experience in terms of social and leisure activities does not meet the needs of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity list is on display on the notice board in the dining room showing the activities planned for the week ahead. Activities such as eye spy, hairdresser, cross-stitch, manicure, sing-a-long and painting are recorded. According to the activity list, one activity takes place every day. The acting manager said that outings take place a few times a year dependent upon the weather. A trip had taken place recently for a pub lunch and all had enjoyed the experience. It was noted at the last inspection that there was no activity programme, no evidence to demonstrate that residents are consulted about social activities and no documentary evidence to demonstrate which residents had joined in Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 18 activities. There is now an activity programme and records are held showing who has participated in activities and who has refused. Surveys had been undertaken with residents and social activity questions were included, also social activities had been discussed at a resident’s meeting. The minutes of the meeting demonstrated that residents had been consulted about activities. A monthly audit of activities takes place, this records how many activities have taken place and how many residents have joined in. The acting manager said that this information will be used to decide whether there needs to be further consultation with residents about activities to see if there needs to be any changes. During discussions it was noted that one activity takes place every day and occasionally activities take place at the weekend. External entertainers such as a keyboard player and physical exercise class takes place twice per month. Jewellery sales and “fashion with fun” take place twice a year. There are no regular church services apart from at times of religious festivals such as Easter and Christmas. Residents are free to visit local churches if they wish. Residents spoken to were complimentary about the Home, two said the only thing that they would change is the activities. Residents did not appear to be satisfied with the amount/type of activities provided. Some of the comments made by residents regarding activities are detailed below: “there is nothing much to do really. Its not up to much, we don’t do something every day and what we do isn’t much good”. “the only thing that I would like changed is the activities, there isn’t an activity every day and some of the activities are not the best which is a shame because sometimes you just sit and think which isn’t always good, you need more to occupy your time. Sometimes it’s OK because everyone is chatty but sometimes they aren’t and then you get bored”. “the activities are OK” “there isn’t much going on, they play bingo occasionally” “activities are not up to much there is nothing going on really” “for a lot of the time you are left to your own devices” “an activity takes place, but not every day and some of the activities such as eye spy are not the best” Although it is noted that activities take place they do not appear to be suited to the wants of all that live at Field view House. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 19 Visitors were seen at the Home on the day of inspection. Staff appeared to have a good relationship with visitors and made them feel welcome. Residents confirmed that their visitors can visit at any time and are always made welcome, “my family visit me, they are offered drinks and made welcome”. Evidence that residents are given choices in aspects of daily living was available in their care files. Likes and dislikes and preferences regarding daily routines were recorded. Residents sign care plan documentation to demonstrate that their care needs have been discussed with them and they are happy with the plan of care to meet these needs. Residents spoken to said that their preferences are taken into consideration as much as possible. Staff were seen encouraging independence and treated residents with respect. A member of staff was observed offering residents the choice of lunchtime meal. The staff member was patient and caring. The choice of meal was crispy pancakes and vegetables or baked fish and vegetables. One resident asked for fish and chips instead. The cook was informed of this and provided the alternative requested. Residents were observed eating their lunchtime meal. Those seen eating fish and vegetables were given the option of having parsley sauce if they wished. Residents appeared to be at ease in their surroundings and were enjoying their lunchtime meal. Residents were complimentary about the meals served. One resident commented that “the food has improved 100 over the last three years”. Another said that the food is “much improved if it is not to your liking you can ask for something different”. Other comments received were “the food is very nice, there is plenty of it, sometimes too much”, “the food is good there is enough of it”. Field View House DS0000004234.V357381.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service users are confident that their concerns will be listened to and acted upon. Systems are in place to protect residents from the risk of abuse, increasing their feeling of safety and their quality of life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received by the Commission or the Home since the last inspection. The complaint log was looked at and this confirmed that the Home had not received any complaints recently. The acting manager is recording any “grumbles” with the action taken to address any issues raised. A quality assurance audit takes place on a monthly basis to audit complaints received. This will enable the Home to take action to address any deficiencies identified in complaints. The complaint policy is on display in the entrance of the Home this tells residents and visitors what to do if they have any concerns. Residents said that if they had any worries they would speak to the acting manager or any other staff. They also said that staff are all approachable and they felt that any concerns would be listened to and acted upon. One resident said that she would “definitely speak to staff and they would sort any problems out. Everything is OK, I have nothing to grumble about”. Another resident Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 21 confirmed that “if I had any worries I would tell the staff immediately and they sort the problems”. Fifty two percent of care staff have undertaken adult protection training. This gives staff the knowledge of how to detect abuse and the action to take if they witness abuse, thereby protecting residents. There have been no adult protection issues since the last inspection. Staff spoken to were aware of the action to take should any issues arise and were aware of the location of adult protection procedures if they needed any further guidance. Recruitment practices were robust and safeguard residents from the employment of unsuitable people. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 22 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 good. The standard of the environment within this Home is generally well maintained providing an attractive, hygienic and homely place to live, therefore improving the quality of life for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken, this including looking at all communal areas such as lounges and dining rooms and a number of bedrooms, including those of the residents being case tracked. The laundry was also viewed. All areas of the Home were clean and hygienic. The main lounge contained a combination of single and two seater settees for residents. There is a fish tank, which appeared to be clean, and the fish well looked after. Some residents were enjoying looking at the fish. Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 23 There are two bathrooms, both of which house assisted bathing facilities. The shower room is going to be changed into a “wet room” as the acting manager feels that this will be beneficial for residents who may find access to the shower easier once the conversion has taken place. A lot of work has taken place regarding the fixtures and fittings since the last inspection. New seating has been purchased for the lounge, a hand-washing sink has been fitted in the laundry. The lounge was reasonably well decorated, clean and hygienic. An issue noted at the last inspection regarding laminate flooring in the corridor, which had “bubbled” and could cause a trip hazard is still ongoing. The acting manager confirmed that the flooring was re-laid but the same problem happened. The manufactures of the flooring are visiting the Home shortly to try to sort the problem. No unpleasant odours were noted during this inspection. Staff undertake a room audit twice a day, all rooms viewed were clean, hygienic and personal belongings were appropriately stored. Bedrooms had been personalised with pictures and ornaments. Emergency call bells are in place in all bedrooms and these were accessible to residents. A shared bedroom seen had curtain screening in place to maintain the privacy and dignity of the residents that live in that room. There is no sluice facility at the Home. Currently the contents of commode pans are emptied down the nearest toilet, they are then taken to the shower room where they are sprayed with disinfectant spray, wiped and then returned to the appropriate bedroom. The acting manager was advised to contact an infection control specialist for advice regarding the best method of cleaning commodes within the Homes current layout etc. The laundry was clean and hygienic. There is one washing and one drying machine. The washing machine has a sluice cycle for washing soiled laundry. All equipment was in good working order. Disposable gloves and aprons were easily accessible to staff and staff were seen wearing these appropriately throughout the inspection. The garden area was well maintained and pleasant to look at. One resident spoken to who spends most of her time in her bedroom said that she enjoys lying in bed looking into the garden. It was noted that there is often rabbits and a fox in the garden and the resident enjoys watching them. The garden slopes and access to the grassed area is via steps making access to this area impossible for those with mobility difficulties. The patio area adjoining the garden is accessible for those with mobility difficulties and provides space for seating to enable residents to enjoy the garden. Field View House DS0000004234.V357381.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate The number of care staff with a National Vocational Qualification (NVQ) level 2 will help to ensure that the skill mix of staff on duty will support meeting the needs of residents. Care needs of those who live at Field view House are met by appropriate numbers of staff on duty. Recruitment procedures protect residents from risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were seventeen people living at Field view House. There were three senior care staff on duty as well as the acting manager, a cook and cleaner. Staffing levels were in accordance with duty rotas examined. Two waking care staff are on duty at night. The cook works between the hours of 8am – 1pm, seven days per week whilst the housekeeper works from 9.30am – 1.30pm Monday to Friday. Care staff are responsible for undertaking cleaning duties during the weekend. Volunteers come into the Home on a regular basis and spend time chatting to residents. At the time of the inspection there appeared to be sufficient numbers of staff on duty to meet the needs of those under their care. Issues were identified at the last inspection regarding duty rotas that did not record the full names of staff on duty and staff working double shifts due to Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 25 shortages. The up to date duty rotas seen recorded the full name of staff and there was no evidence of staff working double shifts. The acting manager confirmed that some new staff have been employed since the last inspection. The inspector was introduced to all staff on duty and conversations were held with two. Both staff confirmed that they really enjoy working at the Home and stated that there have been a lot of improvements recently. It was noted that staff work well as a team and are provided with all of the equipment needed to be able to do their job properly. These staff members were aware of the action to take if they witnessed an act of abuse and were also aware of the Home’s whistle blowing procedure. Both reported a good relationship with the acting manager and said that the Home owners and the acting manager are approachable and they would speak to them if they had any concerns. Residents were highly complimentary about staff saying that they were “friendly and approachable”, “kind and caring” and “all lovely”. Some of the other comments received are detailed below: “I cannot praise the staff enough, the food is excellent, the laundry and cleanliness is good” “Staff are wonderful, all are kind and friendly. They are quick to help out. At night they check on me regularly when I call my bell it is almost as if they were waiting outside the door” “staff are lovely” “all staff are lovely, kind and friendly” “staff are all lovely and helpful and spend time chatting to me in my bedroom” Training records seen show that fifty two percent of staff have obtained the national vocational qualification in care at level two and twenty five percent of staff have this qualification at the higher standard of level three. Undertaking relevant qualifications in care goes some way to ensure that the staff are trained, motivated, and able to meet the needs of those under their care. Three staff personnel files were reviewed to identify whether robust staff recruitment and training procedures are in place. All files seen contained application forms, written references, criminal records bureau and protection of vulnerable adults checks. The Home’s recruitment procedures ensure that appropriately trained and experienced staff are employed. An issue was identified at the last inspection as criminal records bureau checks were not available for all staff. The acting manager gave assurances that these are now available for everyone including the volunteers who visit the Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 26 Home. The random sample of files reviewed contained criminal records bureau checks. The acting manager has started to keep a training log which records at a glance the percentage of staff that have undertaken training courses. Training in dementia awareness, protection of vulnerable adults and safe handling of medication is undertaken. All staff should undertake mandatory training such as moving and handling, fire safety, food hygiene and infection control. The training log shows that a small percentage of staff need to undertake this training. The acting manager was reminded that all staff must receive regular updates in mandatory training. It was noted that this training had already been arranged at their sister Home and staff that required this training were obliged to attend. Fire training has been arranged for 16 April 2008. A training and development plan was forwarded following the inspection. This document records the names of staff that either require initial or update training and the types of training to be provided. The dates on which training is to be provided was not recorded. However, it was pleasing to note that the manager is aware of the training required and the staff that need to attend. Induction training was discussed and it was noted that the Home undertake one day induction/orientation training. New staff then “shadow” an existing staff member for one week, observing working practices and being observed. The Home currently do not undertake induction training in line with skills for care requirements. The relevant induction training should be obtained for use with new staff employed, particularly those who do not have national vocational qualifications in care. Field View House DS0000004234.V357381.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The home is managed by an experienced and competent person who supports the needs of staff and residents. The quality of the service provided is maintained to a high level and is run in the best interests of those people that live at Field view House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Changes have taken place regarding the management of the Home. The deputy is working as the acting manager until the manager returns to work. The acting manager has worked hard to address issues raised at the previous inspection. Proof of action taken to address some of the issues raised at this inspection was sent to us before this report was written which shows that the Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 28 management of the Home are pro-active and eager to address issues identified. The acting manager appeared to be enthusiastic and dedicated to meet the needs of those under her care. On call cover is provided by the acting manager plus two senior carers. The Home owners also provide cover as necessary. This ensures that any issues that arise can be addressed by senior staff with relevant knowledge and experience twenty-four hours a day. One resident said that the “owners are all very approachable and the manager and owners do their job well”. Management systems and practices appear to be working well and improvements have been noted since the last inspection of the Home. The Home has a structured quality assurance system in place. Resident’s meetings have taken place in February and March 2008. The Home are planning to hold four meetings per year. Regular staff meetings take place but there has been a poor response to relative’s meetings and so these are no longer held. Satisfaction surveys are sent to residents, district nurse and GP. The results of the surveys are analysed and details of action taken are recorded. Results of satisfaction surveys are available in the Service User’s Guide. Charts are used as a way to show the results of these surveys in an easy to understand format. The acting manager reviews the Home’s progress against all national minimum standards on a monthly basis and completes a report. Policies and procedures are reviewed on a regular basis and the acting manager and owner have devised new policies recently. The quality assurance systems and practices in place show that the Home are obtaining the views of the residents and acting upon their wishes were possible. The Home encourage improvement and respond positively to areas where improvements are required. The spending money records of three residents were reviewed, including one of the resident’s being case tracked. A discrepancy was noted in one of the resident’s accounts. Funds were checked against the spending money log and receipts available. On one occasion there was no documentary evidence to demonstrate that a small amount of change remaining from a purchase had been returned to the resident’s spending money account. It was noted that receipts were not always obtained for items such as sweets as the newsagents did not issue them. The manager was asked to complete an audit of all spending money records to ensure that balances were correct and receipts available. Following the inspection the manager forwarded notes of a meeting Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 29 and it was recorded that staff have been informed that they must obtain receipts for all purchases, including for small amounts such as sweets to enable spending money records to balance. These receipts are used as evidence that resident’s funds are not mismanaged. Confirmation was received that resident’s spending money records are now being audited on a monthly basis. A policy regarding resident’s spending money and records has also been devised. A copy of the audit undertaken shortly after the inspection was forwarded to demonstrate that spending money logs now balance with funds and receipts were audited to ensure that they have been obtained. A number of records were reviewed to evidence whether the health and safety of staff and residents is maintained. Emergency lighting, records of fire drills, fire alarm checks and hot water temperature records were reviewed and all were up to date and in good order. The cook has worked hard and the Home have recently been awarded a Gold Standard Food Hygiene Award by the local environmental health department. This demonstrates that the Home operate to a high level in terms of food hygiene and safety. When all staff have attended mandatory training the Home will be able to ensure that staff adopt safe working practices which do not put themselves or residents at risk. No other health and safety issues were identified during this inspection. Field View House DS0000004234.V357381.R01.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 Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 31 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 32 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. 1. Standard OP7 Regulation 15 Requirement Care plans must detail the actions to be taken by staff so that residents’ can be confident their needs can be met. This gives staff clear instruction of the action to take to meet identified care needs. 2 OP9 13 The Medication Administration Record must accurately reflect the medications being given to residents. The Registered Manager must ensure that all staff receive regular updates regarding mandatory training. This is to ensure that people in the home are protected from the risk of harm. 4 OP30 12 Documentary evidence must be available to demonstrate that induction training in line with the Skills for Care Council and is being undertaken by staff. 03/06/08 19/05/08 Timescale for action 03/06/08 3 OP30 13 03/06/08 Field View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 33 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 OP7 Good Practice Recommendations Daily entries should contain information linked to care needs and should demonstrate any interventions carried out by staff to meet people’s care plan goals. More detail should be recorded on nutritional intake monitoring records to clearly record the quantity of food eaten. Personal hygiene monitoring records should record personal hygiene tasks undertaken i.e. wash, strip wash, bath or shower. Risk assessments in place should be reviewed at appropriate intervals in accordance with the level of risk identified. Documentary evidence should be available to demonstrate that action is taken to reduce the level of risk. All medicines must be stored in a room where the temperature is below 25°C at all times to maintain their stability in compliance with their product licences Further consultation with residents or if appropriate their relatives or representatives should take place to determine any hobbies and social interests. Arrangements should be made for residents to have the opportunity to engage in a programme of activities that is suited to their individual needs and abilities. Further advice should be sought from an infection control specialist regarding the current methods of cleaning commodes. Suitable arrangements should be made for the safekeeping of resident’s monies and accurate records maintained of expenditure. Receipts should be available for all purchases including confectionary. DS0000004234.V357381.R01.S.doc Version 5.2 Page 34 2 OP8 3 OP8 4 OP8 5 6 OP9 OP12 7 OP26 8 OP35 Field View House Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 View House DS0000004234.V357381.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!