Inspection on 26/09/06 for Field View Residential Care Home

This inspection was carried out on 26th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Residential Care Home 30/11/07

Field View Residential Care Home 20/02/06

Field View Residential Care Home 26/09/05

Field View Residential Care Home 12/01/05

Field View Residential Care Home 08/06/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Field View Residential Care Home Thompson Park Thompson Road Sunderland SR5 2SH Lead Inspector Mr Alan Baxter Key Unannounced Inspection 10:40 26 and 27th September 2006 th 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 Residential Care Home DS0000015748.V294677.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 Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Field View Residential Care Home Address Thompson Park Thompson Road Sunderland SR5 2SH 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) 0191 549 7272 0191 549 7373 PAMELA.BEALE@TISCALI.CO.UK Julie12-@tiscali.co.uk OR pam.beale1@tesco.net Memory Lane Care Homes Limited Julie Anne Howe Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (40), Physical disability over 65 years of age (6) Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection Brief Description of the Service: Field View provides care to older people over the age of 65 years, twelve of whom may have dementia or mental health needs and six people who may have a physical disability. It provides personal care only and any health care needs are dealt with by the Community Nursing Services. The house is purpose built and occupies a site on which previously stood a nursing home and is well known in the area. All areas of the house offer disabled access and a passenger lift offers access to the first floor accommodation and facilities. The home is detached and stands in its own grounds with well-established trees and is approached by its own walled entrance; this leads to a private car park. Though it is located in the heart of the Southwick community it has a feeling of seclusion due to its location and large expanse of external space. There is a large garden to the rear of the home that can be used by service users and their visitors. There is access to a bus service, which offers easy access into the City centre where a range of services and shops can be accessed. Close by there is a range of shops within both the Seaburn and Southwick areas and there is easy access to the metro station at Seaburn. Information about the home is available in its ‘Statement of Purpose’; in the form of a brochure (‘Fieldview Residential Home’) available in the entrance to the home; and in information posted on the home’s notice board in the entrance lobby of the home. These last two need to be updated. The weekly fees charged are from £359 to £374. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two consecutive days in September 2006. It took about nine hours in total, and was carried out as part of the normal statutory inspection process. Information was collected about the service both before and during the site visit. All communal areas of the premises were viewed as well as a number of bedrooms on both floors. A process called ‘case tracking’ was used to check the quality of the care received and this included looking at residents’ care records. A sample of other records such as health and safety were also looked at. Discussion took place with the staff on duty and with about ten service users and also relatives who were visiting at the time of the inspection. Time was also spent observing staff practices. It is understood that the people who live in this home prefer to be referred to as “residents”; therefore this term is used throughout this report. The judgements made are based upon the evidence collected both before and during the visit. What the service does well: The home has a pleasant and welcoming atmosphere. Residents are noticeably well groomed. Residents said that they are happy in the home, and are well treated by the staff. The home gets an assessment of a new resident’s needs from that person’s social worker, before that person is admitted. This should mean that the home can meet all of those needs. The person and their family are encouraged to visit the home, before a final decision is made. Relatives said that they are also happy with the care being given, and say that the home keeps them informed about their relative’s progress, and are consulted, where this is needed. Residents’ medicines are given to them with great care. Where possible, they can take their own medicines. Residents said that the staff treat them with respect at all times, and that their privacy and dignity are protected. Relatives said the same. Residents also Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 6 said that they are given choice and control over their daily lives. This is shown in their care records, as well. The home encourages families and friends to keep in contact, and makes them welcome in the home. They can also attend the monthly residents’ meeting and give their views. Relatives say that any complaints are treated seriously, and are acted upon. The home is clean, hygienic, and free from unpleasant odours. It is pleasantly decorated, has a homely feel, and is safe and well maintained. Most of the staff have certificates to show that they are competent at their jobs. Generally, the level of staff training is good. The home is very careful as to who it employs and conducts all the necessary checks on a new worker, before that person can start work. Staff take an obvious pride in their work. The home is well managed, with an experienced and qualified manager in post. The home takes good care of any money it holds on behalf of any residents. The home is able to show that it takes the health and safety of the residents and its staff seriously. What has improved since the last inspection? A new way of setting out the plans for the care of residents has been introduced. This should make them clearer to staff and to residents. There has been some improvement in social activities, with regular monthly clothing, jewellery and toiletries parties being held. Menus have been recently revised, and now give more choice and variety. The security of the building has been improved, with a new door alarm fitted, and staff practices tightened up. There is much less chance of any resident wandering out of the building, now. The medicine fridge now has its temperature checked every day, to make sure it is safely storing residents’ medicines. The accounts of money held on behalf of residents are now clearer and can be more easily checked, so better protecting residents’ finances. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Information in the home’s brochure and on its notice board is not up to date and means service users aren’t kept up to date with changes. Not all the necessary assessments are being carried out on people wishing to come into the home. This means that some areas of need may not be fully identified until some time after they have been admitted to the home. Adequate arrangements are in place for people wishing to move into the home where they are invited to visit the home and meet the residents and staff, before they make a final decision. This enables them to make an informed choice. The home does not provide intermediate care. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 10 EVIDENCE: It was noted that information available in the entrance lobby to the home, in the form of the home’s brochure, and on the notice board in the entrance lobby, was several years out of date. In the case of the brochure, the home is not carrying out its advertised specialised dementia care programme (see standard 30, below). Case tracking was used to follow the care and support received by six residents (four new residents and two longer-stay residents) from admission. This looked at their experience of the admission process and other aspects of their care. The home gets an assessment and care plan from a resident’s social worker or care manager before he or, she is admitted to the home. In addition, the home does its own assessment before admission, but this wasn’t clear as the assessments were not always signed and dated. This must be done, as it will show that the home knows it can meet the needs of the resident when he or she comes into the home. The home is slow in completing its more detailed ‘in-house’ assessment, with some examples taking more than a month to complete. Also, some areas of assessment, including new residents’ nutritional needs, risk assessments, moving and handling, social needs and skin care, are not being completed. Longer stay residents generally have all areas of assessment completed. Comments cards were sent out to relatives. Four returned their cards. All four said that they are happy with the overall care that their relation is getting in the home. All four also said that they are kept informed as to their relation’s progress, and are consulted as to their care, where appropriate. People thinking about coming into the home are invited to visit the home before admission to meet staff and other residents, before making up their minds. This will help them come to an informed decision about the home and whether it will suit them. All seven residents who returned questionnaires said that they had been given enough information about the home before they moved in. The home does not provide intermediate care. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Some residents do not have care plans in place to meet the needs identified in their assessments. Where care plans are in place, they achieve an adequate standard. Because not all assessments and care plans have been completed, the home is not able to fully show that every health need has been identified and met. Residents may take responsibility for their own medicines, if they are able to do so. Where staff have responsibility for medicines, they follow good policies and practices which protect the residents. Storage of the medicines trolley must be improved. Residents clearly feel that they are treated with respect, and also that their privacy is protected. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 12 EVIDENCE: It was a requirement of the last inspection report that the new care plan format must be introduced as discussed during the inspection. This is now in place. Of the six sets of care records seen, two did not have any care plans in place (even though they had a range of mental health and behavioural problems) and two more had some, but not all, of their needs met in care plans. None of the six care records sampled had a care plan for social or spiritual needs (although some other care records did have, the manager said). It is important to have these in place, so as to give care to the ‘whole person’ and not just meet their physical needs. The home is slow in drawing up care plans for new residents. In one case, it took thirteen days from the date of admission; in another, it took thirty-three days. Ideally, the home should complete its assessment of need far enough before a new resident is admitted to give them time to have care plans ready and in place when the person comes into the home. It should not take more than the first week. Where care plans were in place, they were of a reasonable standard but the quality varied. Some examples were rather general and unspecific; others were detailed and informative, and would allow a new worker to give the care needed by that resident. Care plans were rather crammed together and it was suggested that each problem/area of need should have its own page. This would give enough room for amendments and further development, in the light of the monthly evaluations of the care plans. These monthly evaluations were on the care records of residents who have been in the home for a long time, but not for residents admitted in recent months (when it would be even more useful, as the staff are finding out about a new resident, and should be updating the initial care plans). The home conducts a general assessment of physical health before admission. However, as noted in standards 3 and 7, above, not all residents have had the full range of assessments nor the required range of care plans drawn up. It is not possible, therefore, to say with confidence that each resident’s health needs are being fully met. One of the seven residents who returned questionnaires said that they ‘always’ receive the medical support they need; six said ‘usually’. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 13 Good records are kept of contacts/visits to and from doctors, district nurses, chiropodists etc. Each resident’s ability to be responsible for keeping and taking their own medicines is assessed. This is good practice. The home’s systems and practices for the storage and administration of residents’ medications were of a good standard. The Medication Administration Record (MAR) was well completed, with no gaps. All handwritten entries are signed and dated. This is good practice. A system of attaching a photograph of each resident to their page in the MAR is being introduced. This will reduce the possibility of medicine being given to the wrong person. There is also a list of staff names, with the initials they use when making an entry in the MAR. This will allow for a clear audit trail, if an error is made. Eye drops are correctly kept in a fridge with a daily temperature check, and are marked with the date they are opened, so that they will not be used beyond the 28-day limit. Medicines are kept in a locked drugs trolley. This must be secured to the wall of the medication storage room when not in use. Staff spoken with confirmed that they had had the necessary training to give out drugs safely, and were knowledgeable about this important task. Staff were seen to respect the privacy and dignity of the residents. They knock on bedroom doors, even when they believe the room to be empty. They spoke politely to residents and to listened carefully to them. Three of the seven residents who returned questionnaires said that staff ‘always’ listen and act on what they say to them; two said ‘usually’; and two said ‘sometimes’. All four relatives who returned comments cards said that they may visit their resident in privacy. Residents also confirmed that they are treated with respect by the staff at all times. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 from evidence gathered both during and before the visit to this service. The home still does not have a regular daily programme of social activities for the residents. Some residents feel bored at times. Residents are well supported and encouraged to keep in contact with their families, friends and the local community. Residents are helped to exercise choice and control over their lives. Menus have recently been reviewed, and now give more choice and variety. Residents say that they enjoy their meals very much. Residents have to wait too long to be served at lunchtime. EVIDENCE: It was a requirement of the last inspection report that a planned programme of stimulating and meaningful activities must be introduced for the residents. This is now in place. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 15 The home has been trying to employ an activities organiser for some months, without success. They have, however, found a volunteer driver for the home’s mini-bus, allowing more frequent outings (five in the past three months, plus two shopping trips) for the residents. The home has also had four fashion parties, four toiletries parties, a jewellery party and a summer faire since January, which residents enjoyed. A weekly activities list has been introduced. This includes dominos, music videos, ‘throw the loop’ and a weekly exercise class, which is very popular. However, records show that, on some days, there are no activities taking place. A more varied and regular activities programme must be introduced. This should be a priority, and should not be left for a future co-ordinator. Only two of the seven residents who returned questionnaires said that there are ‘always’ activities that they can join in; four said ‘sometimes’; and one said ‘never’. There are no restrictions on visitors (other than the right of any resident to refuse to see a guest, which is respected) and residents can see their visitors in private. Residents are encouraged to keep in regular contact with their family and friends, and also to keep their links with the local community. Staff will often take a resident with them if going to local shops and there are occasional visits to local pubs. One resident attends a local day club. There was evidence in the residents’ care records that the staff attempt to allow residents to take as much control of their lives as they are able. This was confirmed by the residents themselves and by visiting relatives. Examples of residents’ choice included when they get up and go to bed; what to wear; what to eat; and whether to see visitors. Residents are consulted in the regular monthly residents meetings. Menus submitted before this inspection were discussed with the manager. Some amendments were agreed to be necessary in the light of some comments from residents, and revised menus were then provided for inspection. These were a significant improvement, Menus now give better choice and variety, and are of a good standard. A cooked breakfast is available daily. Lunch gives two hot choices for the main course, with a good range of vegetables and hot and cold choice for dessert. The tea meal also gives two choices, always including at least one hot option, and a choice of dessert. Supper is specified, and is a choice of sandwiches, crumpets, malt bread and Horlicks or other hot drink. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 16 Fresh fruit is prepared and taken round to the residents every day. This is good practice. Lunch was observed in the first floor dining room. Tables were pleasantly set, and residents were offered a choice of orange squash or tea. The lunch was sampled. It was roast chicken with stuffing, carrots and butter beans, with salad as alternative. Dessert was sponge and custard or yoghurt. The meal was well cooked and presented, and staff gave calm and unhurried assistance, where required. In a questionnaire returned before this inspection, one of the seven residents who responded said that they ‘always’ like the meals in the home; four said ‘usually’; and two said ‘sometimes’. However, all those who spoke to the inspector said that they enjoyed their meals. It was noted in the last inspection that there was a wait of fifteen minutes between residents being seated and being served their meal. An even longer wait was observed on this inspection, as residents were being seated at 12.15pm and it was 1pm before the last residents started their meals. This was discussed with the manager. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 17 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 from evidence gathered both during and before the visit to this service. There is a robust complaints procedure which residents and their families know that any complaint will be taken seriously and acted upon. All staff have good and constant training about how best to protect the residents from abuse. EVIDENCE: Four relatives returned ‘comments cards’ before the inspection. Two said that they knew of the home’s complaints procedure, and two said that they had made a complaint. One relative complained about named clothing going missing. A second relative said that “Any complaints are dealt with and are usually just minor comments i.e. lumpy mash.” The home uses a ‘Complaints and Incidents’ book. It would be useful to have a separate book for each, as it is not clear which entries are in which category. Many of the entries in this book describe incidents of challenging behaviour on the part of some residents. These include many references to nipping, punching, and other physical and verbal aggression. Where these result in injury, they must be entered in the accident book (see standard 38, below). Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 18 The large numbers of such aggressive incidents suggest the need for a review of staffing levels and/or staff practices. At present there is no careful analysis of the data be undertaken, with specialist advice taken, where necessary. Where any issues of concern relating to protection of service users have been raised, the correct actions have been taken with Social Services and the police informed immediately and appropriate care plans put in place. However, most of the large numbers of acts of aggressive behaviour noted in the ‘Complaints and Incidents’ book have not been reported under the local ‘Multi Agency Partnership for Protecting Vulnerable Adults’ (MAPPVA), and it was not clear what would trigger such a referral. Protocols have not been regularly reviewed and revised as necessary. All senior staff and established staff have been given training in protecting their residents from abuse, and there is a rolling programme to make sure all other staff are given this training. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 19 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): 19,26 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Residents have a safe, well-maintained, homely and welcoming environment. The home is kept in a very clean, pleasant and hygienic condition and has no unpleasant odours. EVIDENCE: All communal areas and bedrooms were in a well-maintained condition. Such is the good general standard of maintenance in the home, the few minor faults noted (for example, a wall heater not working; a missing bin lid) stood out. These were addressed immediately. It was particularly noticeable that wallpaper is standard throughout the home, making for a very attractive environment and a warm, homely atmosphere. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 20 All fire doors, including residents’ bedroom doors, have magnetic closures, allowing them to be kept open, safely, if the resident so wishes. Care should be taken to identify any resident whose privacy or dignity may be compromised by their disinherited behaviours, if their door is kept open. Another noticeable feature of the home was the almost total lack of odours, even though many residents have continence problems. All staff are complimented on this. Four of the seven residents who returned questionnaires said the home is ‘always’ fresh and clean; three said ‘usually’. One commented that the home is “exceptionally fresh and clean”. No safety issues were identified. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 21 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 this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels had dropped below the agreed minimum levels before this inspection, but were immediately raised when this was questioned. Nearly three quarters of the care staff hold a National Vocational Qualification (NVQ). This shows a high level of competence in the staff group. The home has good policies and practices for recruiting new staff. These make sure that the residents are protected from people who might harm them. Good levels of staff training are given, but not all staff have received training for working with people with Dementia. This means that those staff may not fully understand the needs of people with dementia. EVIDENCE: It was a requirement of the last inspection report that staffing levels must be reviewed, due to the increased dependency levels noted, particularly on the floor dedicated to the care of persons with dementia-type illnesses. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 22 There was no evidence of a formal review. Staffing levels were below the previously agreed levels of four carers on the first floor, three on the ground floor, and three at nights, in that there was only three staff on the first floor. This pointed out to the manager, who agreed to immediately re-instate the fourth carer on the first floor. Feedback about staffing levels from residents and relatives was mixed. All four relatives who returned questionnaires said that there was always sufficient numbers of staff on duty. However, only two of the seven residents who responded said that staff were ‘always’ available when they need them (four said ‘usually’ and one, ‘sometimes’). One resident commented “Always seem to be short-staffed”. It remains to be seen whether putting the fourth carer back on the first floor unit will be enough. The home has not considered what part staffing levels have played in the lack of assessments and care plans, the poor social activities programme, the slow meals, the high levels of challenging behaviours, the lack of quality assurance systems and the lack of specific training in working with Dementia (see standard 30, below). Three quarters of the home’s care staff have achieved a National Vocational Qualification (NVQ) in care, at level two (17 staff) and level three (5 staff). This exceeds the target of 50 , set down in this standard. It means that most of the staff have been able to formally demonstrate their competence in working with this client group. The employment records of two recently employed staff demonstrate robust and thorough employment practices are followed. These include fully completed job application forms, with detailed and complete employment histories demanded; two written work references; proof of identity; and checks of Criminal Record Bureau and Protection of Vulnerable Adults lists. All these issues are designed to prevent inappropriate and unsafe people being employed, and so protect the residents. It was not possible to check that all staff have had the necessary induction, foundation and mandatory training, without going through every staff member’s individual personnel file, as no central records are kept. The manager agreed to collate all staff training onto one central record, and this was promptly submitted. This document showed that there is a good commitment to staff training, with a wide range of externally provided training topics being offered and a good take up of training opportunities by staff. Induction training has been given to all staff. Many more than the expected 50 of staff have achieved NVQ competence. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 23 It was established, however, that only four members of staff have received any recent specific training in working with people suffering from Dementia and associated illnesses. All staff working with this client group must be given the appropriate training (especially important, given the high levels of challenging behaviours noted in standards 16 and 18, above). Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home’s registered manager, Mrs Julie Howe, is very experienced, is well qualified and is of good character. She is fit to be in charge and is able to carry out all her responsibilities. Although the home asks residents their opinions about the home in monthly meetings, it has yet to develop proper systems of quality assurance, and so can’t fully show that the home is always run in the best interests of the residents. The home takes good care of its residents’ finances. Although the home does generally promote and protect the health, safety and welfare of both the residents and the staff group, albeit some areas that haven’t fully developed. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home’s Registered Manager, Mrs Julie Howe, has managed care homes for more than ten years. She holds the Registered Manager Award. She also holds nursing qualifications (RMNH and ENB998) and training qualifications D32 and D33. She is, therefore, suitably experienced and qualified for the post she holds. A meeting is held with the residents every month. Family members are welcome to attend. Good minutes are kept of these meetings, and these minutes are displayed on the home’s notice board. The minutes show that a wide range of topics are discussed with the residents, including social activities, the menus, trips out and complaints. The tone is positive and responsive to residents’ wishes. However, no formal quality assurance systems are in place to gauge the views of the residents, their relatives and friends, and of other interested parties. No questionnaires are sent out. No annual development plan was available and most policies haven’t been reviewed or updated. Previous advice given to the home about the need to have a financial audit trail has been followed. The accounts sheets for each resident for whom money is held are numbered, as are the receipts, which are cross-referenced to the accounts. Residents are encouraged to sign for any transaction from their accounts, if they are willing and able to do so. This is good practice as it keeps them involved with their own affairs. It was a requirement of the last inspection report that the manager must take steps to ensure that the safety of residents is not compromised and that staff must not deactivate door alarms. This has been implemented. A new buzzer was fitted to the door, and staff practices were changed to improve the security for the residents. The fire logbook showed that most of the required checks and tests of fire safety equipment are being carried out. However, it was noticed that fire extinguishers were not being visually checked on a monthly basis, as is recommended by the Fire and Rescue Service in the front of the logbook. The accident book entries also showed that some of the entries in the ‘Complaints and Incidents’ book (see standards 16 and 18, above) referred to residents receiving minor injuries such as skin flaps and minor abrasions. Many of these injuries are not being recorded in the accident book. It was advised that the main focus for the recording of all accidents and injuries should be the accident book. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 26 The home’s policy about how incidents are recorded where residents have nipped or hit another resident, or a staff member, this is not to be recorded in the accident book because it is ‘deliberate’ act, not accidental. Where such assaults had taken place, health and safety risk assessment weren’t in place as part of the care planning process to protect those involved. Servicing and maintenance records are in place, and are being kept up to date. The registered manager records all repair and maintenance issues. It was advised that the date of repair/replacement should be recorded to demonstrate that repairs are being dealt with promptly. Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The information about the home made available in the ‘Field view Residential Home’ brochure and on the home’s notice board must be kept up to date. The home must complete all parts of its assessment of new residents, fully and promptly, with date and signature of the person completing the assessment. A detailed care plan must be drawn up promptly for each area of problem or need identified in the assessment process, including social care needs and (where appropriate) spiritual needs. Care plans must be evaluated at least monthly, and must be updated, where necessary, in the light of such evaluations. 4. OP8 12 The home must make sure that it can demonstrate that every health need for each resident is being met. DS0000015748.V294677.R01.S.doc Timescale for action 30/11/06 2. OP3 14(1) 31/10/06 3. OP7 14 (1), 15 31/10/06 31/10/06 Field View Residential Care Home Version 5.2 Page 29 5. OP9 13(2) The drugs trolley must be secured to the wall of the medication storage room when not in use. A planned programme of stimulating and meaningful activities must be introduced for the residents. (This is outstanding from 31/07/06) 31/10/06 6. OP12 16 (2), (m) 31/10/06 7. OP15 16(2) The home must examine its mealtimes and practices to minimise how long residents have to wait to be served. The home must review its policy on what it should report under its ‘Multi Agency Partnership for Protecting Vulnerable Adults’ (MAPPVA) responsibilities regarding incidents of physical aggression committed by residents on other residents or on staff. A copy of any revised policy is to sent to the CSCI. The home must review its staffing levels in the light of the lack of assessments and care plans, the poor social activities programme, the slow meals, and the high levels of challenging behaviours, and act on its findings. The home must not change from the staffing levels agreed with the Commission for Social Care Inspection without its permission. 31/10/06 8. OP18 13(5) 30/11/06 9. OP27 18(1) 30/11/06 10. OP30 19(1)(5) A central record of all staff training, including induction, foundation, NVQ, mandatory and specialist training, both given DS0000015748.V294677.R01.S.doc 30/11/06 Field View Residential Care Home Version 5.2 Page 30 and planned, must be kept. 11. OP33 24 A formal quality assurance 31/12/06 systems must be introduced to gauge the views of the residents, their relatives and friends, and of other interested parties. An annual development plan must be drawn up. Policies must be kept under review and updated, where necessary. 12. OP38 23(5) Fire extinguishers must be visually checked on a monthly basis, as recommended by the Fire and Rescue Service in the front of the logbook. All minor injuries to residents such as skin flaps and minor abrasions must be recorded in the accident book. All incidents involving aggression by residents, such as nipping and hitting, must be recorded in the accident book. Where such assaults have taken place, the home must carry out a health and safety risk assessment and must put in place suitable care plans to protect those involved. 30/10/06 Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 31 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 Each care plan should have enough room to be able to demonstrate that it is being properly evaluated every month, and updated where necessary. The recording of complaints should be separated out from the recording of other incidents. It is strongly recommended that a careful analysis of the data regarding acts of physical and verbal aggression by residents is undertaken. Specialist advice should be taken, where necessary 2. 3. OP16 OP18 Field View Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Residential Care Home DS0000015748.V294677.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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