Inspection on 08/06/05 for Fieldgate Nursing Home

This inspection was carried out on 8th June 2005.

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

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

Other inspections for this house

Fieldgate Nursing Home 30/10/08

Fieldgate Nursing Home 09/01/07

Fieldgate Nursing Home 14/11/05

Fieldgate Nursing Home 07/02/05

Fieldgate Nursing Home 09/09/04

Fieldgate Nursing Home 10/07/03

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Fieldgate Nursing Home 153 Portsmouth Road Horndean Hampshire PO8 9LG Lead Inspector Anita Tengnah Unannounced 8/6/05- 10:00am 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 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. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fieldgate Nursing Home Address 153 Portsmouth Road, Horndean, Hampshire, PO8 9LG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02392 593352 Extraservices Limited Mrs Muriel Joy Emery CRH 39 Category(ies) of PD- Physical Disability: 39 registration, with number PD(E)- Physical Disability over the age of 65 of places years: 39 TI- Terminally ill: 39 TI(E)- Terminally ill over the age of 65 years: 39 Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1- Service users must not be admitted under the age of 55 2- One service user, Date Of Birth 09/04/1954 can be admitted below the age of 55. Date of last inspection 7/2/2005 Brief Description of the Service: Fieldgate nursing home is a registered care home providing nursing and personal care to 39 service users in the older person category. The home is situated in a residential area close to local amenities. The service users accommodation comprises of seven single rooms and sixteen shared rooms and there is a passenger lift that allows access to both floors. There is a variety of aids and assisted baths to meet the needs of the residents. The service also benefits from a large and well maintained garden with access for wheeelchair users. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place over one day on the 8th of June 2005. As part of the inspection process a tour of the building was undertaken. The inspection took place over 6 hours. The inspector spoke to 11 service users, 3 relatives, 7 staff and the manager. The process included examining care records, staff records and discussions with service users, staff and visitors. What the service does well: What has improved since the last inspection? The home has an ongoing programme of refurbishment and the first floor corridor, lounge, bathrooms and a number of service users bedrooms have been refurbished. One bathroom was in the process of being refurbished. Access to the garden has been improved following a new path has been laid and a further patio area was being created in the garden that will allow for seating area in the garden. The laundry area has also been refurbished and the flooring was impermeable. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 6 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. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 8 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 standard(s) 1,3,6 The home has a good pre assessment process and information is available to service users prior to admission enabling them to make an informed choice. EVIDENCE: The home has a statement of purpose and information was available to service users prior to admission to enable them to make an informed choice. A copy of this was also available in the entrance hall. The manager assesses all service users prior to admission to the home to ensure that their needs can be met. These assessments were available in all service users records examined on the day of the inspection. The service does not provide intermediate care. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 9 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 standard(s) 7,8,9 ,10 The system of care planning was good and regular reviews ensure that service users changing needs are reflected. The staff have good understanding of service users support needs and evident that good relationships have been formed. The recording of medication is poor in some instances and could be detrimental to service users welfare. EVIDENCE: Arrangements were in place to meet the needs of service user. Care plans were formulated on admission and included comprehensive manual handling assessments. A care profile sheet was available in all service users rooms inspected that gave a quick reference guide of service users needs. The manager stated that carers are encouraged to use the care plans that are updated by the named nurse. Care plans were updated and reviewed to reflect any changes in the needs of service users. All service users are registered with GP’S and the manager reported that a number of service users had retained their own doctor on admission to the Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 10 home. Wound care plans were in place that were detailed and reviewed on a regular basis. The home has a policy and procedure for receipt and returned of medication. All medication was maintained securely including controlled drugs. The inspector noted that ointment prescribed for one service user was used for another service user. This was discussed with the manager as this is an illegal practice and medication prescribed must only be used for the named service user it has been prescribed for. There was also a number of occasions that administration record of medication prescribed were not recorded on the Medication Administration Record (MAR) sheet as maintained by the home, this was discussed with staff and the manager. The home is required to ensure that a record is maintained of all medication administered to service users. A review of dressing prescribed for named service users was discussed, as these were not recorded on the MAR sheet. Service users and relatives spoken to were complimentary with regards to the care they were receiving. It was evident from interaction observed that the staff had developed good relationships with both user groups. Relative stated that they were confident in approaching staff and that any issues raised were dealt with appropriately. Service users said that they liked living at the home and that staff were very kind and they were well cared for. One service user that occupied a shared room reported that this arrangement worked well for her and that she was happy with this. Screens were available in all shared bedrooms ensuring that the privacy and dignity of service users are maintained. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 11 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 standard(s) 12, 15 The meals and activities are well- managed providing choice and variety to meet the needs of service users. EVIDENCE: The home has an activity coordinator and some service users reported that they enjoyed the activities provided such as games. The home has developed a room that contains soft lighting, slides and music. The manager reported that this is used regularly and service users enjoyed this facility. The local vicar visits on a monthly basis and service users receive communion as requested. The manager reported that links are maintained with the local church group that attends the home regularly. A number of service users and relatives spoken to stated that meals were very nice and something to look forward to. Lunchtime meal was observed being served and appeared well balanced, nourishing and nicely presented. Staff were available to offer support with meals in a sensitive manner. A choice of meals was offered, this was evidence by the menu seen and confirmed by service users. Meals were taken in the dining room or service users own room as they preferred. It was noted that hot dessert was left with 2 service users before they had finished their meals. This was discussed with the manager and Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 12 will be reviewed to ensure that hot desserts are served at the appropriate times as required. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 13 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 standard(s) 16,18 The home has a satisfactory complaint procedure that ensures safety and welfare of service users. EVIDENCE: The home has a complaint policy and procedure. Service users and relatives stated that they would approach the nurse in charge or the manager if they had any complaints. One relative reported that issue that she had raised on previous occasion was appropriately dealt with. A complaint log is maintained and there has been one complaint since the last inspection that has been resolved. The home has the Hampshire Adult protection procedure and the manager has also developed a flow chart to help staff in reporting all allegation of abuse. There has been one report of allegation of abuse that was investigated as adult protection guidelines and was not substantiated. The manager reported that she has facilitated training in adult protection and ensuring that all staff have the information required to report any malpractice. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 14 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 standard(s) 19, 20,24,25 There is an ongoing refurbishment programme; the décor and furnishing provided a warm and homely atmosphere. Specialist equipment is available to promote and maintain the independence of service users. The present window restrictors on the first floor level may be detrimental to service users safety. EVIDENCE: A tour of the premises was undertaken as part of the inspection. It was evident that an ongoing programme of refurbishment was in place. A number of the areas at the service had been refurbished including two communal bathrooms. The home was clean and welcoming. Service users bedrooms were personalised and it was evident that service users are encouraged to bring in items of personal belongings on admission. One bathroom was in the process of being refurbished. Another bathroom on the ground floor was in a poor state Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 15 of repair and impersonal. The manager reported that this was planned for refurbishment this year. Work was near completion with regards to the path leading to the large wellmaintained garden. A patio area is also planned in the garden that will provide extra seating for service users. The garden was accessible to wheelchair users and a ramp was provided. Service users stated that they enjoyed spending time in their rooms with their personal belongings around them as they choose. The service had a variety of equipment and adaptation to maintain and promote service users independence. A review of storage facility for mobile equipment such as hoists should be undertaken to ensure the safety of service users. It was noted that on two occasions first floor bedrooms windows were wide opened. This was discussed with the manager and a review of the window restrictors on the first floor is required so that they meet with the health and safety regulation and protect the welfare of service users. The restrictors although present, still allowed for the windows to be opened fully. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 The present system of staff recruitment can be detrimental to the safety of service users. EVIDENCE: A sample of staff record was seen, it showed that the manager interviews all applicants and a record of the interview was maintained. Staff are provided with the terms and condition of employment. One staff record did not contain CRB disclosure as required and also no confirmation of his entitlement to work in this country. There were two references available and were from friends and none from the last employer. The manager must ensure that all checks are carried out prior to employment for the protection of service users. All records should be maintained as per schedule 2 Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,37 The manager is supported well by staff in providing guidance and staff demonstrating clear awareness of their responsibilities. The system of record keeping is satisfactory and ensures protection of service users. EVIDENCE: The manager is a registered nurse and it was evident that she has the support of senior staff in her fulfilling her role. Service users and relatives spoken to stated that they would approach the manager with any concerns. The inspector observed good interaction between the staff, service users and the manager. There are clear lines of accountability within the service. All records were maintained securely. Reports as per regulation 37 are sent to the Commission as required. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x x 3 2 x STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x 3 x Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 19 NO Are there any outstanding requirements from the last inspection? 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 9 Regulation 17(1) (a) schedule 3 Requirement The manager must ensure that a record is maintained of all medication administered to service users. Prescribed medication must only be administered to person that this is prescribed for. The manager must ensure that consent for the use of bedrails is recorded and used within a risk assessment framework. A review of window restrictors on the first floor is required to ensure the safety of service users. The manager must ensure that all appropriate checks are completed prior to staff employment for welfare and protection of service users. Timescale for action 30/07/05 30/07/05 30/07/05 2. 18 13(7) 12(3) 23(2) 3. 25 30/07/05 4. 29 19 Schedule 2 30/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 20 Fieldgate Nursing Home Standard 1. Fieldgate Nursing Home H54 S11488 Fieldgate V231600 080605.doc Version 1.30 Page 21 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire 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. 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