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Inspection on 29/06/06 for Fieldhead Park Care Home

Also see our care home review for Fieldhead Park Care Home for more information

This inspection was carried out on 29th June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Some residents have good access to activities and go out regularly to church and to go shopping. The home has a minibus which is used to enable residents to go out on trips. Care staff seem to have built good relationships with residents and there was a good amount of humour observed on the day of this inspection visit between residents and staff. Care staff were enthusiastic about their jobs and the training they have undertaken. Care staff evidently work well as a team and support each other.

What has improved since the last inspection?

Since the last inspection, all staff have received Adult Protection training. All staff have completed health and safety training. Nearly all staff have completed movement and handling and fire training. The fire schedule work set by the West Yorkshire Fire service has been completed.

What the care home could do better:

Care records are generally of a poor standard and put residents at risk because they are not accurate and do not address the true needs of the residents. Medication systems are not adhered to and put residents at risk. Feedback from residents indicates that activities do not always include everyone. Mealtimes and meal provision does not always meet the needs of residents. Complaints need to be viewed positively in a view to improve provision at the home. Work needs to be done to ensure residents are protected from abuse. The safety of residents is not always maintained, hazardous substances and items such as cleaning products and lubricating oil and a sharp kitchen knife were left in areas of the home accessible to service users. Bathrooms are not adequately cleaned. The recruitment process and records need to be improved. Managers need to check the competence of staff. The management team at the home need to ensure they know what is happening in the home and quality audits need to be carried out.

CARE HOMES FOR OLDER PEOPLE Fieldhead Park Care Home 140 Kitson Hill Road Mirfield West Yorkshire WF14 9QZ Lead Inspector Helen Battle Key Unannounced Inspection 29th June 2006 09:40 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 Fieldhead Park Care Home DS0000001083.V296201.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. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fieldhead Park Care Home Address 140 Kitson Hill Road Mirfield West Yorkshire WF14 9QZ 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) 01924 496517 01924 496317 fhpark@rochehealthcare.com Roche Healthcare Limited Mrs Maria Hawksworth Mrs Amanda Joy Jones Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person aged under 65 years of age To accommodate a maximum of two services users aged between 55 and 65 years in the ten intermediate care bed unit. 2nd February 2006 Date of last inspection Brief Description of the Service: Fieldhead Park is a care home providing accommodation and personal care for 54 persons who are experiencing issues relating to the ageing process. Ten of the places are reserved for persons requiring intermediate care. The accommodation is an extended and adapted former Victorian detached property in its own grounds. It is owned by a private limited company that own other homes in the West Yorkshire area. All but two of the bedrooms are for single occupancy; all the rooms have ensuite facilities. The facilities are based over two floors that are joined by two passenger lifts. The home has a number of lounges and dining facilities. The home is sited some distance from the town of Mirfield, within a short distance of some local facilities. The provider informed the Commission for Social Care Inspection on the 29.6.06 that the fees range from £332.98 to £575.00 per week. There are additional charges for hairdressing, newspapers, magazines, private chiropody and specialist therapy (eg. aromatherapy). Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit carried out by two inspectors. The inspectors arrived at the home at 9.40am. One inspector left at 3.45pm and the other inspector left at 5.35pm. During this visit we spoke to some of the residents, some of the staff and the home’s management. We also read care records, audited a sample of medications, reviewed staff recruitment and training records, and looked around communal areas of the building. Prior to the inspection, ten resident questionnaires were sent to Fieldhead Park to obtain the views of residents living at the home. Six completed questionnaires were returned. Surveys were sent to ten relatives and friends of residents, GPs and social workers. At the time of writing this report, the inspector had received five responses from relatives, one social worker and one GP. Other information used as part of the inspection process included notifications from the home to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, and a pre-inspection questionnaire completed by the manager. The inspectors would like to thank everyone for their assistance during the inspection process. What the service does well: Some residents have good access to activities and go out regularly to church and to go shopping. The home has a minibus which is used to enable residents to go out on trips. Care staff seem to have built good relationships with residents and there was a good amount of humour observed on the day of this inspection visit between residents and staff. Care staff were enthusiastic about their jobs and the training they have undertaken. Care staff evidently work well as a team and support each other. Fieldhead Park Care Home DS0000001083.V296201.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 Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 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 the following standard(s): 3, 6. Service users have their needs assessed prior to admission into the care home. Service users assessed and referred solely for intermediate care are not always helped to maximise their independence. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: One of the managers of the home was out assessing a prospective resident at the beginning of this inspection. This was reported to be the usual practice. This is different on the intermediate care unit as residents often are admitted at short notice with copies of a social work assessment. Basic assessments are then carried out on admission. One resident stated that she had been to visit the home before making the decision to go and live there. Of the six resident comment cards received, two stated that they did not have enough information prior to admission to the home, whereas four said they did. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 9 There was no evidence from looking at the care records of two residents who had spent time on the intermediate care unit that residents are always helped to maximise their independence. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 10 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. Not all service users’ health, personal and social care needs are set out in the individual plan of care. Risk assessments are not monitored as they should be. Service users are not protected by the home’s medication policy and procedures. Service users are treated with dignity, respect and privacy. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Care records for five residents were examined. None of the five records were complete. All had some assessments in relation to tissue viability, falls, oral health and moving and handling, however not all these assessments were complete. Where a risk had been identified, there was not always a care plan developed. Care plans did not meet all the needs of the residents. In some areas, particularly in relation to pain control and tissue viability, there were serious concerns for the health and welfare of the residents. One particular situation raised such concern that the managers of the home were asked to carry out a full investigation into the case and report back to the Commission. A further random visit will be made to assess the safety of the residents on the intermediate care unit, where the most serious concerns were raised. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 11 A requirement was made in the last inspection report regarding care plans requiring more detail, particularly in regard to wound care. This has not been met and further concerns are raised. Failure to make improvements in this area may lead to enforcement action. A requirement was made in the last inspection report regarding the management of medication in the home. Since then a random inspection visit was made to the home on the 14th June 2006 to check medication procedures following a concern which was brought to the attention of the Commission. During that visit, procedures were found to be unsafe and an immediate requirement form was issued. Following this, nursing staff were provided with up-to-date guidelines, policies and procedures and spoken to as a group by the managers of the home. During this inspection visit on 29th June 2006, medication checked could not be tallied with the records held. Records were not accurate and, in their current form, could lead to serious mistakes being made, compromising the safety of the residents. This is not acceptable. Nurses must take responsibility for their own practice and accept that they are accountable. Failure to address this requirement may lead to enforcement action being taken. During this inspection, residents appeared generally to be well groomed and their privacy and dignity maintained. Staff spoke to service users in an appropriate manner and it was observed that residents were relaxed with staff and in approaching them with suitable banter. All five responses to the relatives questionnaires stated that they could visit in private. Of the six questionnaires received from residents, five said they usually receive the care and support they need and one said they always do. Three said that staff always listen to them and act on what they say, one said that staff usually listen and two said they never do. Three residents said that they usually receive the medical support they need, two said that they usually do and one said that they sometimes receive the medical support they need. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 12 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 Generally, the service users’ cultural, religious, social and recreational needs are being met, and they are supported to maintain contact with their family and friends. The service users are able to exercise choice and control over their lives. The home provides the service users with a varied and nutritious diet. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Various activities are organised at the home. Photographs of a recent trip to the National Coal Mining Museum, an Easter bonnet competition and 100th birthday celebrations were displayed in the entrance area to the home. A summer fayre has also been arranged to be held within a few weeks of this inspection and residents spoken to stated that they had been busy making arts and crafts to sell at the summer fayre. One resident said that they had enjoyed doing the craft work and that the activities organiser is “very good”. This was also confirmed in one of the resident questionnaires. Other activities residents said they enjoyed were bingo and going out. A minibus is available for residents at the home. A church service is held at the home every month. The dates for these services were displayed near the Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 13 entrance of the home and this was also confirmed by residents. One resident stated that they go out to their own church every week. One resident was busy setting the tables for lunch and said that they enjoyed doing this to keep busy. Residents were seen to be sat outside enjoying the sun in the afternoon of this visit and were seen to come and go into the various lounges and into their bedrooms. Other residents spoken to said that there wasn’t much to do. This conflicting information about the amount of activities provided was also reflected in the questionnaires from residents. Of the six received, two said that there were always activities available, one said usually, two said sometimes and one said that activities were never available. This is an area which should be audited to ensure that all residents are aware of what is provided and when, also to ensure that all residents get the same amount of input. Residents confirmed that they are able to have visitors and see them in private whenever they want. On the morning of this inspection visit, residents on the intermediate care unit were seen to be having breakfast after 10 am. Two residents in the main part of the home informed inspectors that they had been waiting for their breakfast for quite some time. This appeared to be very close to the lunchtime meal which is served at 12.00 hrs. The managers of the home should look into this practice and review whether this suits the residents. The inspectors were pleased to be invited to eat lunch with the residents on the day of the inspection. The main meal was chicken casserole, roast potatoes, mixed vegetables and brussel sprouts. The meal was nutritious, however it was observed that a number of residents left the meat and said that it was fairly hard to chew. General feedback about the meals was that they were adequate. Of the six resident questionnaires returned, two said that they never enjoy their meals and four said that they usually do. This is also an area which needs to be audited and observed by the management team at the home. Residents are able to exercise choice over their lives. This was confirmed by a resident stating how and when they like to get up, go to bed, stating that they don’t like to be disturbed from their chosen seating during the day, and how they spend their day. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 14 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 Service users, their relatives and friends are not always confident in raising any concerns and complaints. The service users are not protected from abuse. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The complaints procedure is displayed near the main entrance to the home. This contains the required information. The home has received two complaints during the last twelve months where the Commission has been made aware. One of these complaints was not responded to within the given timescales. Two other complaints were documented at the home which had been dealt with appropriately. A specific issue was raised in one of the resident questionnaires which related to lack of communication with a resident who was to move to another placement from the intermediate care unit. The management team at the home were asked to look into this to ensure that this was not repeated and that practice improved. Of the six resident questionnaires received, two said that they would always know who to complain to, two said that they would usually know and two said that they would never know. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 15 Of the five relative comment cards received, four said that they have had to make a complaint and one said that they were not aware of the complaints procedure. It was confirmed by the managers at the home that all staff have received Adult Protection training. However, due to the issues raised about the medication practice and the specific issues raised on the intermediate care unit, residents are not always protected from harm. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 16 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 The service users live in a safe and overall a well-maintained environment that is generally clean and hygienic. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Generally, the home is well maintained and is clean. There were no unpleasant odours noted during this visit. Some specific areas were observed to be in need of attention. In the bathroom opposite the kitchen, the tiles were cracked and dirty, ivy was growing through the window into the bathroom, the shower was dirty and toilet cleaner was left on the shelf, which could be a risk to residents. In the toilet near the dining room the light pull cord did not have a handle, making this impossible to wipe clean and making it difficult for residents to Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 17 grasp hold of. The toilet seat was chipped and therefore cannot be cleaned effectively and the bin lid was cracked. In the bathroom opposite room 46, it was observed that there was bar of soap left in the shower; this is a potential source of cross infection. Toiletries were left on the shelf, there was no bin lid, soiled laundry was left in a bin with no lid, a piece of soiled tubifast (bandage) was left on the radiator, the shower tray was dirty, the shower chair was rusting, the shower curtain was torn and wire was loose coming out from the top of the radiator. These are all health and hygiene hazards. Of the six resident questionnaires received, three said that the home was always clean, two said that it usually was and one said sometimes. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 18 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 Staff are employed in sufficient numbers and receive induction and ongoing training, although this is not always within expected timescales. The recruitment process must be improved to ensure the service users are sufficiently protected by the home’s recruitment policy. Not all staff are competent in all aspects of their job. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Rotas examined indicate that there are sufficient numbers of staff in place to meet the needs of the residents at the home. This was confirmed by a group of four staff who were spoken to during this visit. It is evident from the serious issues raised on the intermediate care unit that there are some staff who are not competent in all aspects of their job. This is compromising the safety, care and welfare of the residents in their care. This is not acceptable and the management team must address this quickly. This feedback was given to the management team before the end of this inspection visit. It was reported that all staff have received Adult Protection training. Movement and handling training is in the process of being updated and one of the Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 19 managers gave assurances that this would be completed in the three months following this visit. It was also reported by one of the managers that fire training for all staff is almost complete and assurances were given for this to be done within one month following this visit. All staff have completed health and safety training, although there were some areas around health and safety that gave concern on the day of this visit. This should be raised perhaps at a team meeting. Staff spoken to confirmed that they had received health and safety training. Training records must be kept up to date as they did not reflect the current situation. Staff recruitment records were not fully available during this visit. This must be rectified. Records of five members of staff were checked. References for one of the staff were not available. On the application form of another there were gaps in employment history and no explanation for these gaps. For one member of staff, there was a discrepancy in the fact that they had commenced work at the home before the full enhanced CRB check had been received, only a POVA first check. This is acceptable practice in exceptional circumstances but requires a risk assessment and appropriate supervision of the staff on duty to protect the safety and welfare of residents. These arrangements were not in place. (One of the managers stated that needing staff is always exceptional circumstances). It is suggested that the management of the home review this and consider the risks carefully. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 20 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 The home is run and managed by two managers who are fit to be in charge. Generally, the home is run in the best interests of the service users. The financial interests of the service users are not adequately safeguarded. Not all the required records kept by the home are up-to-date and accurate. The health and welfare of service users and the staff is not promoted and protected. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The two managers at the home job share. The newly registered manager is currently undergoing management training. It is concerning that neither manager was aware of the serious issues raised regarding the intermediate Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 21 care unit prior to being informed by the Commission. Quality audits may have alerted the management team to these issues if they were in place. It was reported that these are due to be implemented in October 2006. It is also concerning that monthly management visits have not been carried out. This is a requirement and these visits, if carried out properly, would have highlighted some of the issues in this report. The personal money held by the home for two residents was checked during this visit. Although the money tallied with the records, there was an omission in one record, where a significant amount of money was not accounted for. The managers need to investigate this and find out where the money has gone. The systems in place should be reviewed to ensure this does not happen again. Discussion also took place about the need to transfer money for residents into their own bank account as the home holds large amounts of cash for some residents which they could be earning interest on. During this visit, it was observed that a can of lubricating oil was left on the radiator in the dining room. Also left out in the dining room was a sharp kitchen knife. A bucket of cleaning products was left in one of the downstairs corridors unattended on the morning of the visit. These are health and safety hazards which put residents at risk. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 22 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 X X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 X X 1 Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 (1)(2) Requirement Timescale for action 01/08/06 2. OP7 12 (1) (a) (b) Care plans must be in place for each resident which sets out how all the residents’ needs are to be met in respect of his health and welfare. The registered person shall 01/08/06 ensure that the care home is conducted so as to promote and make proper provision for the care, health and welfare of service users. Previous timescale 01/04/06 not met. The registered person shall make 01/08/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Previous timescales of 02/02/06 and 21/06/06 not met. The registered person must make arrangements, by training of staff or by other measures, to prevent service users being harmed or suffering abuse or DS0000001083.V296201.R01.S.doc 3. OP9 13 (2) 4. OP18 13(6) 01/08/06 Fieldhead Park Care Home Version 5.2 Page 24 being placed at risk of harm or abuse, ie unsafe medication practice, not providing adequate care and treatment. Previous timescales 01/12/05 and 01/04/06 not met. Satisfactory checks (appropriate CRB) and references must be in place for staff prior to commencing work at the home. The registered person must ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home, and, so far as practical, service users, are aware of the procedure to be followed in the case of fire including the procedure for saving life. 5. OP29 19(1) (b)(c) 23(4) 01/08/06 6. OP30 01/08/06 7. OP30 13 (5) Previous time scales of 01/11/05 and 01/04/06 not met. The registered person must 01/10/06 make suitable arrangements to provide a safe system for moving and handling resident. Previous timescales of 01/11/05 and 01/04/06 not met. Suitably qualified, competent and experienced staff must be in place to ensure the health and welfare of residents. The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care in the care home. Previous timescales of 31/03/05 and 01/04/06 not met. Monthly management visits must DS0000001083.V296201.R01.S.doc 8. OP30 18 (1)(a) 01/08/06 9. OP33 24 (1) 01/10/06 10. OP33 26 31/07/06 Page 25 Fieldhead Park Care Home Version 5.2 11. OP35 17(2) 11. OP38 13(4) be carried out and a report regarding this visit produced. A copy of this report must be forwarded to the Commission every month. Accurate records of all monies put into safekeeping for residents and all monies returned to residents must be kept. All hazards in the home as far as reasonably practicable must be removed e.g. kitchen knife, toiletries, cleaning substances, oil. 15/07/06 15/07/06 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. 4. Refer to Standard OP6 OP12 OP15 OP16 Good Practice Recommendations Residents in the intermediate care unit should be helped to maximise their independence and return home. Activities should be reviewed to ensure that all residents have access suitable to meet individual needs. The meals provision should be reviewed so that the meals and mealtimes meet the needs and preferences of residents. Complaints received by the home should be dealt with in a more open manner and viewed more positively, in order that the home improves and makes progress. The damaged tiles in the bathrooms and the ivy growing in through the bathrooms window should be addressed. Bins should have lids on. The light pull cord should have a handle on. Bathrooms should be cleaned thoroughly. Soiled laundry should be dealt with appropriately, ie lids on laundry bins. The staff at the home should continue working towards achieving the NVQ level 2 qualification. DS0000001083.V296201.R01.S.doc Version 5.2 Page 26 5. OP19 6. 7. OP26 OP28 Fieldhead Park Care Home 8. 9. OP29 OP35 Managers should check that residents are in safe hands at all times. Gaps in the employment histories of staff should be explored. Systems in place to safeguard residents monies should be followed at all times. The reason for unaccounted for monies should be explored and the resident reimbursed. Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Fieldhead Park Care Home DS0000001083.V296201.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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