CARE HOME ADULTS 18-65
Fieldhead Back Lane, Skelton Road Langthorpe Boroughbridge North Yorkshire YO51 9BZ Lead Inspector
Mrs Maggie Coxon Key Unannounced Inspection 26th July 2006 10:00 Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 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.V305779.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 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.V305779.R01.S.doc Version 5.2 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.V305779.R01.S.doc Version 5.2 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. 24th October 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.V305779.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on the 26th July 2006. This visit was carried out by one Regulation Inspector and took 5 hours plus 3 hours preparation time. This site visit forms part of the first key inspection of this home since April 2006. The home returned the requested information in a pre inspection questionnaire before this site visit. The site visit comprised of an inspection of some areas of the home, examination of various records, discussions with residents, staff and the management of the home and observation of activity in the home and of interaction between residents and staff. Information was also used from the pre inspection questionnaire submitted by the registered provider. What the service does well:
Staff provide a good standard of care for residents in an endeavour to ensure that they are well looked after. This promotes their sense of wellbeing. Residents can develop and maintain relationships with friends and family. This promotes their emotional wellbeing. Residents are given information about what services are provided and about charges. This means that they know what they are entitled to and what they have to pay for this. Prospective residents would have their needs assessed so that they and the staff team could be sure that their needs would be met should they move into the home. Residents and staff work together to produce a plan of how the resident’s needs and wishes can be best met. This gives residents a say in planning services they will receive. Residents receive medical help whenever they need it ensuring that their health care needs are met. Residents and their relatives are asked what they think about the service provided so that the manager and staff team can make changes to improve residents’ quality of life. Residents have a good choice of food and drinks at mealtimes. This ensures that they have a varied diet of their choosing.
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 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.V305779.R01.S.doc Version 5.2 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.V305779.R01.S.doc Version 5.2 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 and 2. Quality in this outcome area is good. A comprehensive assessment process and information provided gives prospective residents an opportunity to choose if they want to move into the home. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Well-detailed information about services offered is included in the home’s statement of purpose and service user guide. These documents are updated as and when any changes to the service are made. This information is made available to prospective service users so that they can decide whether or not the service can meet their needs prior to moving in. Whilst no new admissions have been made in recent years there is a preadmission assessment procedure that would be undertaken, which would involve the acting manager meeting with any prospective resident and their family/carers and undertaking an assessment of need. This information would be made available to staff to ensure that they would know how best to meet the social, personal and emotional needs of the individual should they be admitted. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 9 If the placement were 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 service users would be listened to and considered before any placement was offered. This ensures that any prospective service user is able to make a decision about moving into the home with confidence. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 10 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, and 9. Quality in this outcome area is good. Service users make many decisions and everyday choices. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users’ care plans are comprehensive and well organized. They contain sufficient detail to ensure that staff know how best to meet the diverse needs of the individual resident in a way that promotes their independence wherever possible. Service users make many choices in their daily lives and are allowed to take reasonable risks subject to an individual risk assessment that is fully recorded. Where safety measures are put in place the reasons for this are clearly documented. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15,16 and 17. Quality in this outcome area is good. Service users enjoy an increasingly broad range of activities giving them greater leisure opportunities to meet their social needs. They are also able to develop and maintain personal relationships, thereby meeting some of their emotional needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The range of activities enjoyed by service users has increased over recent months and the acting manager and staff team have been arranging more outings and holiday breaks for individuals. Daily routines in the main promote service user choice and freedom of movement with any agreed restrictions recorded in an individual’s plan. There was a recent allegation made however that a staff member denied a service
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 12 user their rights in this area and this alleged incident is currently subject to an adult protection investigation. Service users are well supported to develop and maintain personal relationships of their choosing including family relationships. Service users were seen to choose what they wanted for lunch and records of meals eaten show that this is usual practice. Lunchtime was very informal and service users were seen to be very relaxed and to enjoy their meal in a pleasant atmosphere. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 13 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): 18,19 and 20. Quality in this outcome area is good. Service users’ personal care and healthcare needs are being met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff were seen to support service users with their personal care needs in a way that promoted the resident’s privacy and dignity. Case tracking identified that each service user is registered with a GP and that they attend healthcare appointments with support from staff. All of the service users have their medication administered by staff. This is well recorded and all medication is securely stored. Some though not all staff have undertaken appropriate medication training. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is adequate. Concerns and complaints are handled promptly and sensitively so individuals can be confident that their complaint will be listened and responded to. There has been a recent shortfall in the implementation of the adult protection procedure. This however has been addressed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A comprehensive complaints procedure is followed. Whilst several of the service users are unable to talk about concerns or dissatisfaction staff observe behaviours and body language to identify these. One service user however has their own complaints book in which they record any dissatisfactions which staff then address. Residents are therefore able to express their views and any concerns and have these dealt with. There are two adult protection investigations being undertaken at present managed by the Local Authority adult protection team. Whilst the carer who witnessed the most recent alleged incident of abuse ensured that this was recorded they did not pass this information immediately to either the adult protection team or to management within their organization. This failure in following the adult protection procedure appropriately had been discussed with the acting manager and service manager and the acting manager had since discussed the code of conduct with all staff. The acting manager explained that whilst the most recent allegation of abuse has had further impact on the home, staff morale remains reasonably good. The acting manager has worked very hard to maintain this.
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 15 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): 24 and 30. Quality in this outcome area is poor. Whilst the home is clean and tidy there are areas that require redecoration and refurbishment to ensure that service users needs are adequately met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Various communal areas have been recently redecorated, as has one bedroom that has also had a new carpet laid. The ground floor bathroom however needs total refurbishment. The bath is currently unusable and one service user has to visit a sister home every other day to bathe. The acting manager said that she has requested a new shower room. A recent environmental health report also required that the kitchen units be replaced as they are no longer non-porous and that new Food Standards Agency guidance regarding working practices be followed and documentation
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 16 be completed. Once again the acting manager has applied for the total refurbishment of the kitchen. Evidence that the Food Standards Agency guidance has been followed has not been available. Those areas seen were clean and tidy. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 17 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): 32,33,34 and 35. Quality in this outcome area is adequate. The home is adequately staffed thereby meeting service user needs. Whilst staff have undertaken some training other training is overdue. Service users would benefit from staff being better trained. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Recruitment and selection procedures are being well followed with all new staff undergoing the necessary checks prior to commencement of employment. Two new staff members are undertaking the learning disability award framework induction and foundation programme and have completed appropriate medication training. The deputy manager has completed NVQ3 and is currently undertaking the NVQ assessors’ award. No other staff have completed a NVQ although some are currently taking the award. Some mandatory training for staff is now also overdue. Having this training could improve the quality of services to service users.
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 18 Staffing levels were appropriate at the time of the inspection and although there are several staff on long-term sick leave duty rosters show that shortfalls are filled by existing staff working additional hours and through the use of bank and long standing agency staff. Staff are employed in sufficient numbers and appropriately deployed to meet service users’ needs at all times. Regular staff meetings take place and the acting manager is planning key worker meetings with individuals. Staff also receive regular supervision. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. Comprehensive health and safety systems and procedures are in operation and the home is well managed with improvements to services continuing to be made. This promotes the well being and safety of the service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The acting manager is managing the home very professionally with the best interests of the service users always in mind and is continuing to undertake the registered managers award and the necessary units in care. Staff say that they feel well supported. Comprehensive health and safety systems and procedures are in operation and records are well maintained. Monthly health and safety checks of the building are undertaken and fire safety measures are well maintained including regular
Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 20 fire safety training for all staff. A risk assessment and appropriate measures have been undertaken with regard to the prevention of Legionnaires disease. There is a team action plan for the home developed in line with the organization’s corporate plan and with the wishes of the service users. The service manager undertakes monthly audits of the service and relatives have been surveyed as to the quality of the service. The acting manager explained that health and care professionals are also to be surveyed. Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 21 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 16(2)(J) Requirement The ground floor bathroom must be redecorated and refurbished to suit the needs of the service users. The kitchen must be repaired or refurbished in line with the requirements of the Food Safety Agency and records required by them must be maintained. All staff must be provided with current mandatory training. Timescale for action 31/10/06 2 YA24 23(2)(C) 31/10/06 2 YA35 18(1)(C) 31/12/06 Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 23 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 Refer to Standard YA20 YA23 Good Practice Recommendations Those staff who have not yet done so should undertake appropriate medication training. Staff awareness of the procedure they should follow on witnessing or suspecting an incident of abuse should be regularly checked and the procedure reinforced where necessary. 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. 3 4 YA32 YA37 Fieldhead DS0000007874.V305779.R01.S.doc Version 5.2 Page 24 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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