CARE HOME ADULTS 18-65
Fieldhead Back Lane, Skelton Road Langthorpe Boroughbridge North Yorkshire YO51 9BZ Lead Inspector
Mrs Maggie Coxon Unannounced Inspection 24th October 2005 15:30 Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 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 Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 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 Adults 18-65. 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. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fieldhead Address Back Lane, Skelton Road Langthorpe Boroughbridge North Yorkshire YO51 9BZ 01423 325052 01423 325052 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) St Anne`s Community Services Mr Michael Edward Priestley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered for 5 Service Users with Learning Disability some of whom may also have a Physical Disability. 5th May 2005 Date of last inspection Brief Description of the Service: Fieldhead is a care home registered by St Annes Community Services to provide personal care and accommodation to up to five younger adults with learning disabilities some of whom may have physical disabilities. The home is a detached, two-storey house that is situated in its own grounds that are set back from a main road in Langthorpe, which is close to Boroughbridge. Local community amenities and facilities, including shops and pubs, are within walking distance for those with good mobility, other than that, transport would be required. Each of the five bedrooms is for single accommodation, two of which have ensuite facilities. These are situated on the ground and the first floor, the latter of which are accessed via a staircase. There are well-maintained garden areas to the rear and side of the house along with an area for parking. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second to be undertaken between April 2005 and March 2006 although an additional visit was undertaken on 15th July 2005 to check on the well being of the residents and staff during investigations into allegations of abuse and following a complaint received by the Commission for Social Care Inspection. It was also to offer support to Ms Della Wilkinson who had very recently been appointed as temporary manager of the home at this very difficult time. This inspection was done on 24th October 2005, at a time when all of the people living in the home would be present. It took 1.25 hours plus 1 hour’s preparation time. Discussions were held with the four people currently living in the home, with care staff on duty and with the Acting Manager. A number of records, systems and most areas of the home, including bedrooms and shared areas, were seen. What the service does well:
Residents indicated that they are happy with the running of the home. They are actively involved in the day-to-day running of the home and are encouraged to make as many decisions and choices in their lives as possible. They are also supported to join in activities in their local community and to maintain contact with families and friends. The home is well run by the acting manager who is working closely with the care staff to support them in providing the best service possible to the residents. The acting manager and staff have developed good working relationships with the residents and communicate extremely well with them. The home is well maintained and was clean, warm and comfortable at the time of this inspection. Several of the residents said that they like their bedroom and they are able to furnish them as they like and include their personal belongings. Staff are well trained. Systems and records are well maintained. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.
Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 4 and 5. Information about the home is made available to any prospective residents and/or others involved in arranging a placement within the home enabling them to make an informed choice. EVIDENCE: A statement of purpose and service user guide have been produced. These provide information concerning services and facilities provided within the home to prospective and current residents and anyone else involved in arranging a placement within the home. Whilst no new admissions have been made in recent years the acting manager explained that she would meet with any prospective resident and their family/carers and undertake an assessment of need. If deemed appropriate, she would then arrange a gradual introduction to the home for the individual concerned so that he or she might meet other residents and staff. Overnight and short stays would then be arranged after which a decision about the placement would be made by all concerned. The views of the other residents would be listened to and considered before any placement was offered. Each of the residents has been provided with a written contract. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,8 and 9. People living in the home make as many decisions and choices about their lives as possible. Any restrictions are recorded in their individual plans and are based on risk assessment. They also live as independently as possible, once again taking into account any risks that have to be considered, with the full encouragement and support of staff. EVIDENCE: The acting manager has reviewed and updated residents’ Individual Life Plans and risk assessments since her appointment and has drawn up an action plan for each individual. This document prioritises actions to be carried out to further improve individuals’ quality of life. Individuals are encouraged more to try new and varied activities with support from the staff team. Each resident had a review of his care earlier this year organized by his care manager and the acting manager explained that she reviews each person’s care plan with the staff team at each monthly team meeting.
Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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 and 17. Residents enjoy an increasingly varied and interesting lifestyle and are fully involved in their local community. They enjoy a range of social opportunities and develop and maintain good relationships with family and friends. They enjoy a wide choice of home cooked, good quality food. EVIDENCE: Whilst only one resident attends organized day care services, all have increasingly active lives within their local community supported by the staff team. They are also involved in the general running of the home. An increased variety of outings are arranged throughout the year and each resident has a holiday or short breaks that they choose themselves again with support. Residents were seen to be generally enjoying a very relaxed lifestyle in the home. They talked about recent activities, outings and holidays organized by staff in consultation with them. Residents shop locally for food and have a say in the meals cooked. The acting manager has sought and implemented advice from an occupational therapist with regard to mealtimes for one of the residents.
Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 and 20. Residents’ personal and health care needs are fully met. EVIDENCE: All of the people living in the home are registered with a local GP through whom specialist health services are accessed as and when needed. None of the residents is able to take their own medication. There is a monitored dosage system in operation, which is securely stored. Medication administration records were well maintained. The acting manager has strengthened this system since being in post and explained that all staff have either completed or have nearly completed appropriate medication training. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Residents’ concerns safeguarded. EVIDENCE: There is a comprehensive complaints procedure in operation that is available in various formats and is made available to anyone who wishes to see it. Several of the people living in the home are not able to make a formal complaint but are able to make any dissatisfaction known to staff, who try to address this promptly and appropriately. One complaint has been made to the C.S.C.I. within the last twelve months. This was found to be unsubstantiated. There is an adult protection investigation currently being undertaken following allegations of abuse made some time ago to the responsible individual for St. Annes Community Services. The organization is following the correct procedure and is carefully monitoring the situation. This matter doesn’t affect the day-to-day lives of the people living in the home. There was a very cheerful atmosphere in the home on the day of the inspection, routines were seen to be very informal and the residents seemed relaxed and comfortable. Staff were seen to have developed very good relationships with residents and to communicate very well with them. are appropriately dealt with and their interests Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25,26,28 and 30. The standard of the environment is good and provides residents with a safe, comfortable and clean place in which to live. EVIDENCE: The home is well maintained and no health and safety issues were noted. All five bedrooms are for single accommodation and are of an appropriate size. One of these has en suite shower facilities and a second has been fitted with an en-suite WC and hand basin. The remaining rooms are all in close proximity to one or other of the two communal bathrooms, one of which has an assisted bath. These two bedrooms have had new carpets lain, have been redecorated and have been fitted out with new soft furnishings. Shared areas consist of a kitchen, a dining room, a lounge and a conservatory. The acting manager explained that the redecoration of all communal areas including the office is to start in November 2005. Appropriate aids, adaptations and equipment are fitted throughout the home. A good standard of cleanliness is maintained throughout.
Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34. The residents receive a good standard of care from a skilled and well-trained staff team. EVIDENCE: Appropriate recruitment procedures were being followed thereby safeguarding the wellbeing of residents. The acting manager explained that the home has a shortfall in care hours of two fulltime residential care officers, which are currently being recruited to. She explained that she is using an agency employee to cover some of these hours. She also explained that a new deputy manager is due to join the team in the near future. The staff team is working hard towards achieving NVQs to level 3 in care. Two of them have now completed the award; two more are currently undertaking it and a third has enrolled to commence training. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The residents benefit from a well managed home in which their needs and wishes are put first. EVIDENCE: The home is very well managed by the acting manager who has worked hard with the staff team to improve the quality of services within the home. Residents and staff were seen to be very relaxed in her presence and to communicate very openly and easily with her. It has previously been noted that the registered manager of the home, a qualified nurse with some management training, was completing three units of the registered managers award as required. It was not possible to ascertain if this had been completed due to his continued absence from the home. The acting manager however explained that she has nearly completed the registered managers award and necessary units in care. St Annes Community Services has a quality assurance and monitoring system in place that includes regular unannounced visits by the Service Manager to
Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 16 check on quality issues. It had previously been recommended that this system be further developed to include ascertaining the views of people who have contact with the home. The acting manager explained that she is currently meeting with or contacting residents’ families to introduce herself. She then plans to send out surveys to families and professional colleagues to ascertain their views on the service. Comprehensive procedures and systems to ensure the safety and well being of residents are in operation within the home. Staff are appropriately trained in health and safety matters including fire safety. The acting manager has introduced a roster to ensure that all systems are regularly checked. She explained that she has been told that due to poor water pressure in the home there is no guarantee that hot water is correctly stored, thereby ensuring that it complies with current health and safety guidance concerning Legionella. She is currently discussing this matter with the organization’s maintenance department with a view to having the problem resolved. Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fieldhead Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000007874.V257053.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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. 2. 3. Refer to Standard YA32 YA37 YA39 Good Practice Recommendations A minimum of 50 of care staff should be qualified to NVQ level 2 or above. The Registered Manager should complete an appropriate management qualification. The views of families, friends, advocates and other people involved with the home, in respect of the quality of services, should be ascertained and incorporated into the quality assurance system currently in operation. Hot water should be stored at a temperature that safeguards against Legionella (at a minimum of 60 degrees Celsius). 4. YA42 Fieldhead DS0000007874.V257053.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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