Inspection on 11/04/07 for Fieldhouse Care Home Limited

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Fieldhouse Care Home Limited 23/01/06

Fieldhouse Care Home Limited 11/07/05

Fieldhouse Care Home Limited 15/11/04

Fieldhouse Care Home Limited 10/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Fieldhouse Care Home Limited Spinners Green Off Whitworth Road Rochdale OL12 6EJ Lead Inspector Jenny Andrew Unannounced Inspection 11th April 2007 07:15 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 Fieldhouse Care Home Limited DS0000042784.V298310.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. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fieldhouse Care Home Limited Address Spinners Green Off Whitworth Road Rochdale OL12 6EJ 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) 01706 632555 01706 356734 Fieldhouse Care Home Limited Francesca Mary Jayne Stewart Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Fieldhouse is a purpose built home located on a residential estate on the outskirts of Rochdale. Accommodation is provided on two floors in 38 single and four double bedrooms. Five of the single rooms have an en-suite facility. Level access is available to the home and a passenger lift ensures access is provided to both floors. The home accommodates male and female service users aged 65 years and over who require residential care. Situated in its own grounds, it has the benefit of small gardens to the side and rear with ample parking available at the side and front of the home. There is easy access to the motorway network and public transport. Weekly fees are from £351.42 to £361.42, as at April 2007. The higher charges are made to people who want a larger en-suite bedroom. Additional charges are made for private chiropody, newspapers/magazines, personal toiletries and hairdressing. The provider makes information about the service available in the form of a Service User Guide and Statement of Purpose, which are given to new residents and are displayed in the home. A copy of the Commission for Social Care (CSCI) inspection report is displayed in the entrance hall so the residents and visitors to the home may read it. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eigh hours and was done by one inspector. The home had not been told beforehand that the inspector would visit. The inspector checked what was written down about the residents (care plans), looked around some of the building and also looked at a number of records. In order to get more information about the home, the manager, deputy manager, nine residents, two care assistants, one day and one night senior care assistants, activity worker, cook, domestic, laundry assistant and three visitors were spoken to. The inspector also watched how the staff cared for the residents. In addition, comment cards were sent out before the inspection to professional visitors, relatives and residents. Of these, 12 relative, six resident and two GP questionnaires were returned and these, together with other information which had been received about the service over the last few months, has been used as evidence in the report. What the service does well: Residents felt they were well looked after by the staff and the following comments were made: “Staff are really good”, “You couldn’t live anywhere better”, “I can please myself what I do and when I do it”, “The staff are great”, “They treat me with respect”, “The staff will do anything you ask them”, “To me, it’s like being on holiday”, “This is an excellent home”, “The staff have a really good attitude”, “We are treated as individuals” and “The manager bends over backwards to help you”. Throughout the inspection, the staff were seen to care for the residents in a kind, caring and sensitive way. The manager made sure the home only cared for those people whose needs the staff could meet. The home kept good records of people’s needs and the care they gave to meet those needs. Staff contacted doctors, district nurses and other health care professionals when residents needed them. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 6 The residents spoken to were all pleased with the meals they received, with choices being offered at each mealtime. They commented: “The meals are wonderful”, “You can have anything you want at breakfast”, “There’s a good choice at each meal”, “The food is spot on”, “If you don’t like the choices offered the cook will give you something else” and “The food is lovely and you can have what you want.” Those people who needed special diets were well catered for and the staff had had training from a dietician so that they could make sure that the frail residents were getting the right food so they would not lose weight. The management team were careful about whom they offered a job to and made sure they did all the right checks before staff started work at the home. The building was clean, well decorated, hygienic and kept in excellent order throughout and the residents spoken with all felt the home was a comfortable and pleasant place to live. The manager was constantly looking at ways the home could improve the quality of life for the residents living there and how they could be more involved in the running of the home. She spent a lot of time chatting to the residents on a daily basis and also watched how the staff cared for them. What has improved since the last inspection? Many of the staff had attended more training courses so they were better able to meet the needs of the people they cared for. The medication records were up to date and the way staff gave out medication to the residents had improved so the home was now operating a safe system. Daily activities were taking place for individual residents, as well as groups. More regular trips out were being arranged which suited the different needs of the residents and they enjoyed going out into the community. Residents were being asked what they thought about the home by attending resident meetings, filling in questionnaires and talking to their key worker or the manager. This meant they were more involved in the running of the home. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The admission process was thorough, with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. Standard 6 was not assessed as the home does not provide intermediate care. EVIDENCE: Four files were inspected and each contained an assessment undertaken by one of the management team who visited the prospective resident in their own home or hospital prior to admission. This ensured that no-one would be admitted whose needs the home would not be able to meet. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 10 In the main, the assessment forms were detailed and addressed all areas of need. In one instance however, where a resident had been admitted on an emergency basis, some of the form had not been fully completed although the information had been obtained on the day of admission. Information from the assessment documents had, where relevant, been included in the residents’ care plans. Two residents were spoken to who had come into the home within the past two months. Both said they had been given a service user guide and were really satisfied with their bedrooms, which they said had been made comfortable for them. They felt their admission had been as good as it could be, given they felt worried and unsure about what to expect. The staff had made them welcome and given them a cup of tea and tried to put them at their ease. They were both now happily settled at the home. All the residents spoken to and returned resident comment cards, confirmed their needs were being well met at Fieldhouse. On the day of the inspection, the deputy manager went out to undertake an assessment in the person’s own home. The manager confirmed that the home had arranged the visit in consultation with the person’s son who would also be present. Good practice was in place with regard to the regular reviewing of needs which involved the resident and/or their family. As the home had several mentally frail residents living there, some of the staff had undertaken dementia care training, in order to understand more fully how to meet these people’s needs. In addition, a further four staff had been booked on the course between June and September 2007. Other needs related training which staff had undertaken was nutrition – seven staff, falls awareness – eight staff and continence awareness – five staff. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being well met but care plans needed to include short-term health care needs to ensure the staff were working in a consistent way. EVIDENCE: Three individual plans of care were inspected, one for a resident who had been recently admitted. All three were detailed and, in the main, had the information that staff needed in order to provide the right care and support to each person. It was noted however, that where short-term care needs had been identified, these were not always part of the individual’s care plan but were recorded in other places within the person’s file. Examples were as follows: where the nutritional tool had been used and where medium or high risk had been assessed, the care plan did not state how the home was addressing the need; where residents had catheters, the care plan did not record what personal care was needed; where pressure sores were being Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 12 treated the care plan did not address treatment and outcome. The staff spoken to were however, very specific about how they addressed all these areas and it was clear the needs of the residents were being extremely well met. Residents’ religious or special cultural needs were recorded on the care plan. The plans were drawn up in consultation with the resident and/or relative and all three plans had been signed. Care plans were reviewed and updated on a monthly basis with full involvement of the resident and/or their representative. Records relating to bathing and weight were in place and all were up to date. The morning handover was observed and the senior in charge gave clear direction to the staff team about their duties for the day. This ensured that all the staff were aware of who was responsible for what task and that residents’ needs for the day were fully met. The names of the residents who had requested a bath/shower that day were recorded on the work rota, along with the time of day they wanted it. Residents spoken to all confirmed they received sufficient baths/showers and at the time of day they preferred to take them. They were given the choice of morning, afternoon or evening baths. Two residents had a bath or shower every day and several had more than one a week. One resident commented that she really enjoyed her evening bath so that she could go straight to her room afterwards and relax. A key worker system was in place and it seemed to work well. The workers were responsible for liaising with relatives and reporting any changing needs of their residents to the senior or deputy. They also did monthly reviews with their residents. Feedback from relative questionnaires and from those people visiting on the day of the visit, indicated they felt they were kept informed of important matters affecting their relatives/friends. All the residents spoken to felt their health care needs were being well met and the six returned comment cards confirmed this was so. Feedback from the 12 relative questionnaires also indicated satisfaction with this aspect of care. Food/fluid/turn/stand charts were put into place for residents who were being cared for in bed or for those assessed at risk and the visiting district nurse said that any instructions she gave to the staff were strictly followed. She confirmed she was always accompanied on her rounds, that staff were knowledgeable about the residents’ needs and that the residents always seemed well cared for. She said the home was always clean and hygienic and never had an unpleasant smell. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 13 Residents had regular access to chiropodists, opticians and district nurses. Referrals through GP’s were made where staff identified problems in other areas, such as dietician, physiotherapy, etc. Visits by health care professionals were recorded on the individual resident’s care plan. The residents spoken with said the home would always send for their doctor if they were feeling unwell. Two GP comment cards were returned. Feedback indicated satisfaction in respect of how the home communicated with them, the ability to see their patients in private, staff’s knowledge and understanding of the needs of the residents and satisfaction with the overall care provided by the home. One GP commented that there was not always a senior member of staff to confer with, but this contradicted the district nurses’ feedback. The night senior gave relevant information to the day staff in respect of health related problems, e.g., someone had a sore mouth, observation of a bruise on a resident and where a resident’s needs had changed to needing full assistance with personal care. The manager and five of the staff had done training with the dietician on how to use the MUST tool (Malnutrition Universal Screening Tool). This was an assessment document that alerted staff to take action if a resident was assessed as being at risk of malnutrition. Following the training, each resident had been assessed but, as previously stated, action plans now needed implementing. Where nutritional supplements had been prescribed, the medication administration records (MAR) showed they were being taken as prescribed. The manager and deputy manager gave examples of where other high calorie snacks had been given to some residents to try and increase their weight. The assistant addressing the sourced from a looking at ways deputy had recently introduced a new assessment tool needs of people with constipation problems, which he had health care magazine. Clearly, the staff team are constantly to improve the health care of the people they cared for. The McMillan nurse had been requested to provide some in-house palliative care training and this was in the process of being arranged. In addition, the manager and six staff had been booked on a dignity and care value base course to be held by Rochdale Social Services Department. All three files contained assessments relating to dependency, moving/handling, Waterlows (skin), nutrition and falls. Where other risks had been identified, assessments were in place, for example, beds being fitted with safety sides. Where such restraint measures were taken, it was in full consultation with the resident and/or their representative. Risk assessments were reviewed on a regular basis. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 14 A pharmacy inspection had taken place on 8th March 2006 when two requirements were made. These were in respect of ensuring that accurate records of medication administration were maintained and adherence to good practice in the management of the medication round. Both these requirements had been met. The MAR sheets checked for three residents were all signed and appropriately completed. The morning medication round was observed and the home’s policies and procedures were being followed. Following the pharmacist’s visit, the manager had been regularly auditing medication records to ensure all staff were following the right procedures and letters sent out to staff were seen. Audits had been done on 5th May 2006, 12th July 2006 and September 2006. She was now satisfied with the way medication was being given out and was now auditing on a less frequent basis. Checks of controlled drugs were done during the inspection and medication in stock, matched that recorded in the controlled drug book. Boots had done a medication audit and found everything to be in order. It was noted that the drug refrigerator temperature was high, with a reading of 14°C when the correct range should be between 2°C - 8°C. The fridge should be replaced or alternative storage arrangements be made. At the time of this visit, there were no residents selfmedicating but the manager said they did ask about this as part of the initial assessment process. All staff responsible for giving out medication, had received appropriate training and certificates were seen. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity were respected at all times. Relatives confirmed they were satisfied with the staff’s manner and attitude towards the people they visited. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included using the right approach and giving gentle encouragement, explaining to people what they were going to do and why so they didn’t become angry and frustrated, encouraging people to be as independent as possible, especially when bathing, locking bathroom doors and knocking on bedroom doors before entering. One resident commented “all the staff, including the men knock on my door before coming in”. Another resident said “the staff respect my privacy and make me feel comfortable when helping me with personal care”. Throughout the day, the inspector noted frequent interactions between staff and residents and all showed a kind and caring attitude. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents were able to follow their chosen lifestyles both in and outside of the home, and varied and nutritious meals were provided for them promoting their good health. EVIDENCE: Residents were able to make choices in many areas of their daily routines but this did depend on their mental frailty. Residents spoken to gave examples of choices they regularly made: where to sit and who to sit with, what to wear, whether to join in with activities or not, when to get up and go to bed, what to eat and where to see their visitors. When residents first came into the home, a brief social history was recorded, involving the resident and/or their relative so that the home would have some information about what kind of things the person had previously enjoyed taking part in and what sort of routine they preferred. During the inspection, residents were seen to get up as late as 10:30 when they could still choose what to eat for their breakfast. Residents were given the choice of whether they wished to have a key to their bedroom and all had lockable drawers in their rooms. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 16 At the last inspection on 23rd January 2006, social activities were not always being provided, due to the activity worker having left. This had been addressed and a new activity worker had been appointed. From speaking to her, it was evident she was enjoying her new role, previously having been a care assistant, and confirmed that she worked Monday to Friday between 10:00 and 16:00. An activity programme was displayed showing that one to one activities were done in the morning with group activities arranged in an afternoon. This seemed to work well. All activities were recorded in a book kept for such purpose and the activity worker would then transfer activities to the individuals’ care plan file on a monthly basis. One resident commented how much she enjoyed going out shopping on a one to one basis. Other one to one activities included hand/nail care, short walks around the home and garden, cards, dominoes, jigsaws, crosswords and other games needing two people. The activity worker said she would also spend time just sitting with individuals and having a chat, if that was what they wanted. There was also a computer installed in the lounge where residents could play electronic patience and other games. Group activities consisted of bingo, beetle drives, quizzes, arts/crafts, gentle exercises, memory games and reminiscence sessions, utilising packs from the local library. The activities were age appropriate and suitable for both male and female residents of differing abilities. Entertainment was also arranged and on the day of the visit, a large screen mobile cinema visited the home in the afternoon, showing Easter parades. The staff made a real effort to make this occasion special, by arranging the chairs so people could see, providing tasty nibbles and serving ice creams during the interval. Several people enjoyed going to a local community centre every Tuesday, supported by the staff. It was usual for four people to go and those reliant upon wheelchairs were also included. Two staff would accompany them and support them whilst there. As part of the admission procedure, each new person was asked if they would like to join the club so they could take their turn to attend. Over the past 12 months, several trips out had been arranged, including Blackpool illuminations (with fish and chip supper), lunch at The White House, three theatre visits and the Imperial War Museum. Several residents commented they had enjoyed at least one of the outings. The residents were also involved in what to put in the home’s newsletter and the activity worker had recently arranged postal votes for those wishing to vote at the local election. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 17 Entries in the visitors’ book identified that many relatives visited on a regular basis. No restrictions on visiting times were imposed. Relatives were invited to activities such as bonfire night celebrations, Christmas parties, theatre trips and craft fairs. Feedback from returned questionnaires indicated they were always made welcome by the staff and could always see their relative in the privacy of their bedrooms. One relative commented “My mother is very well cared for and I visit regularly at varied times.” Provision was made for residents to continue to follow their chosen religions, with regular attendance at the home by representatives from both Church of England and Roman Catholic faiths. One resident said the Vicar who used to visit her at home came regularly to the home to see her. Feedback from residents about food, both from questionnaires and from interviews, was positive about the quality, amount and choices offered. Resident meetings were now being held on a more regular basis and they were also asked to complete satisfaction questionnaires and comment on things like the food. The cook and manager had recently reviewed the menus to include even more choices at every meal. The residents had also been involved in this process. The cook was knowledgeable about the individual likes and dislikes of the residents. One resident said “They never give me anything with cheese in it” and another said, “The staff will always find something to tempt me as I’m not a good eater”. From checking the four weekly menus, it was identified that a good selection of food was offered at each mealtime. The menus were displayed on each dining table so that the residents could see what was on offer. Residents were particularly complimentary about breakfasts and lunches. They said they could have anything they liked for breakfast, such as bacon sandwiches, scrambled, boiled or poached eggs, sausages, cereal, porridge and toast. All these were observed being served at breakfast. Two hot choices were served at lunchtime and desserts were served at both meals. In addition, residents enjoyed suppers and said they could have cakes, biscuits or toast. Milky drinks were also offered. Residents also said if they didn’t like what was on the menu, they would be offered something else. One resident had ordered a banana sandwich for her tea. On the day of the inspection, the lunch choices were lamb hotpot or sausage rolls served with leeks, swede and boiled potatoes, followed by rice pudding. The inspector sampled the lamb hotpot. The meat was tender and the dish was tasty. Gravy was served by staff in gravy boats so that residents could choose how much to have. At teatime there was always a hot snack, soup and sandwiches or salad, followed by cakes or a dessert. Menus showed that a good assortment of vegetables and fruit was offered over the week and fruit was cut up and served in an afternoon. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 18 The individual dietary needs of residents were being well met and dietary and fluid charts were completed as and when needed. As previously stated, all residents had been assessed using the Malnutrition Universal Screening Tool (MUST). The cook used sugar substitutes when cooking, so that any resident following a diabetic diet could enjoy many of the same foods as the other residents. The dining area was well decorated and furnished. Those residents who needed some assistance or prompting with their meals were sensitively assisted. Whilst all the present service users were white British, the manager gave examples of how a previous resident’s cultural needs had been met by the cook. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which residents were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: A complaints procedure was in place which was included in the service user guide and statement of purpose. Each resident had a copy of the service user guide in their bedroom. Two returned relative questionnaires said they were unaware of the procedure, although it was displayed within the home. A complaints log book was in place and since the last inspection, three complaints had been logged. The manager had taken appropriate action to address the problems which had been raised. Where recordings were of a sensitive or personal nature, cross reference to where the write-up was filed had been made. The outcome for the residents had been recorded and all parties had been kept advised. The Commission for Social Care Inspection had not had cause to investigate any complaints about the home over the last 12 months. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 20 The residents spoken with all felt they could speak to the manager or any of the staff about problems and that they would be listened to. One resident said the resident meetings were a good way to raise any issues and that things would then be changed. It appeared the manager and staff were good at addressing areas of concern that either residents or their relatives raised, before they became a complaint. In addition, the manager spent time on an almost daily basis, chatting to the residents to make sure they were happy with their care. The people spoken to all said they felt safe living at Fieldhouse. A procedure for responding to allegations of abuse was available, as was the Rochdale Inter-Agency Protection of Vulnerable Adults (POVA) procedure. One protection investigation had taken place over the last year. The manager and staff had followed the correct procedure and notified all relevant parties, including the Commission for Social Care Inspection and Police. It was to the manager’s credit that even when the Police advised they felt they had insufficient evidence to proceed, she continued to pursue the matter, resulting in a successful Police prosecution being made and the worker being placed on the POVA register. All correspondence relating to the matter was seen, including a letter of confirmation from the Department of Health to say the worker had been placed on the list. The majority of the staff team had already done NVQ training or were in the process of undertaking it. Units on protection were included in this training. In addition, the Manager and 12 staff had done the Rochdale MBC POVA training. More staff were due to do the training but Rochdale Social Services Department cancelled the last booked training day. The manager stated she would be booking more staff on any future courses, but that, in the meantime, she would ensure that any new staff received the in-house abuse training which she facilitated as and when needed. Staff files showed that Criminal Record Bureau and POVA first checks had been done before any new staff started work so as to ensure that the staff were suitable to work with vulnerable people. The manager was aware of the need to involve advocates and/or volunteers where residents did not have any next of kin, so that the residents’ rights would be protected. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was clean, safe, hygienic and well maintained providing a comfortable and homely environment for the residents. EVIDENCE: The home was safe, accessible and well maintained. Those people with mobility difficulties were able to access the home easily as level access was provided to the front door. A passenger life was provided to the first floor and handrails were fitted to both sides of corridors throughout the home, enabling the less mobile residents to maintain their independence. Toilets and bathrooms were well equipped to enable people to retain their independence as far as possible. The manager had arranged for one resident to have a reassessment in order that she could revert to using an electrical wheelchair and this had now been facilitated. The wheelchairs were all fitted with footplates. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 22 One resident commented on how much she appreciated her wheelchair being kept clean. Everyone spoken with thought the home was a safe place to live and work in. The home employed two part-time maintenance workers who were also responsible for the upkeep of the lawns and gardens. A maintenance book was in place where the manager and/or staff recorded jobs that needed to be done. These were quickly acted upon, ensuring the residents lived in a safe environment. For safety purposes, the home had CCTV cameras directed on the entrance hall and car park. Since the last inspection, the home had received visits from the Greater Manchester Fire Department and Environmental Health. The fire report requirement had been addressed and there were no requirements made in the Environmental Health report. The communal areas of the home were well decorated, bright and comfortable. Whilst there was only one large lounge, the chairs had been imaginatively positioned so that people could sit together in small groups. There was a maintenance and refurbishment programme in place. As bedrooms became vacant, they were re-decorated and refurbished if necessary. The manager said that some of the recently vacated bedrooms had been totally refurbished, which had included replacing the bed, furniture, curtains, carpets and bedding. She had recently purchased 12 new lounge chairs, four beds and six commodes. In addition, a further five lounge chairs and eight coffee tables were on order and two more bedrooms had been identified for full refurbishment. One empty room was being decorated at the time of the inspection, which a new resident was to move into the week following the inspection. One resident said how much she had appreciated being able to move rooms, following the bereavement of her husband. She said the manager and staff had been extremely sensitive to her needs and she was being involved in choosing the colour scheme and new furnishings for the room. Where residents shared a bedroom, when a single room became vacant, they were asked if they would like to move. Bedrooms were personalised and residents were able to bring in personal items and ornaments with them. Relatives and residents were very complimentary about the cleanliness within the home and said that the home did not have any malodours. A walk around the building supported this view and the home was spotlessly clean throughout. One relative commented, “Fieldhouse is a friendly, clean environment, with dedicated staff and management”. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 23 An infection control policy was in place and several of the staff had undertaken relevant training. The manager was aware of the need for all staff to attend this training and was awaiting new training dates so she could book the remaining staff on the course. The staff interviewed described safe infection control practice. Disposable gloves and coloured aprons were provided for staff use and to reduce the spread of infection, liquid soap and paper towels were supplied in all bedrooms, bathrooms and toilets. Disposable laundry bags were also used for heavily soiled bedding. The laundry was sited away from the food preparation area and was clean, well decorated and orderly. Sufficient and suitable equipment was provided. The laundry assistant was spoken with. She said there was only one unmarked cardigan waiting to be returned to a resident and upon checking the “returns” laundry basket, this was able to be confirmed. The laundry was staffed every day and residents spoken to said they did not have any problems with lost clothing and were never given anyone else’s clothing to wear. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Sufficient numbers of staff with an appropriate skill mix were provided. Recruitment procedures showed that all references and checks had been undertaken, ensuring staff were suitable to work with the residents. EVIDENCE: Inspection of rotas showed that the home was well staffed, especially in the morning, when it was usual for nine care staff to be on duty. This only dropped in instances where a member of staff had rung in sick at the last minute. In the afternoon, it was usual for six staff and the activity worker to be on duty. The staffing levels were more than adequate to meet the needs of the current resident group and feedback from all 12 returned relatives/visitors comment cards indicated there were always enough staff on duty. The deputy manager had recently changed her time to come on shift in order to better meet the needs of the residents in a morning. She was now starting work at 07:00 so that the four night staff were able to devote their time to assisting residents wishing to get up, instead of spending time serving breakfasts. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 25 All the residents interviewed were satisfied with the care they were receiving. One person said, “I’m never rushed in a morning, the staff let me take my time” and another resident said “The staff let me do what I can for myself, even though I’m in a wheelchair”. The staff spoken to felt they were able to do their jobs adequately with present staffing levels. The provision of ancillary staff was good, with cooks, kitchen assistants, domestics, laundry assistants and two maintenance workers being employed. Since the last inspection there had been some changes in the staff team but the turnover was not considered excessive and this enabled the residents to build up good relationships with the staff who they trusted. Whilst the resident group were all white British, the home operated an equal opportunity recruitment policy and five of the staff were from other ethnic backgrounds. The needs of the workers were well met, with one female carer, because of her culture, not assisting with the personal care tasks of male residents. The gender of staff was good, with five male carers working at the home. This meant that the male residents could choose to have a male carer, to assist with shaving, bathing, etc. Female residents were asked upon admission if they had a preference in respect of the gender of care assistants but at the time of the inspection, staff said only one person preferred a female carer. Feedback from both day and night staff, indicated staff morale was high, resulting in good teamwork by an enthusiastic workforce that worked positively with residents to improve their quality of life. The manager made sure that staff had the necessary information to undertake their roles efficiently and effectively. Good communication systems were in place, e.g., staff handovers, communication book, regular supervision, team meetings, work rotas, etc. The manager was committed to offering training opportunities to the staff and the company had funded the deputy manager and assistant deputy so they could undertake their NVQ level 4 training. One of the conditions of employment was that staff would be willing to attend training courses requested of them. Of the 22 care staff currently employed, two had completed NVQ level 4, four done NVQ level 3 and a further five had successfully completed NVQ level 2 training. In addition, six staff were currently undertaking their NVQ level 2 training. This meant the home had already achieved 50 of trained staff and this would further increase when the care assistants had finished their current training. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 26 Inspection of records showed that safe recruitment and selection practices were followed in line with the home’s procedure. These included receipt of two satisfactory references, Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks. A voluntary worker was currently working at the home and the manager had obtained references and a CRB check before she started work. Staff were also given copies of the General Social Care Council “Codes of Practice” upon appointment and personnel files contained staff signatures to say they had been given a booklet. The manager said that when staff left without notice, they sometimes had to appoint staff before the full CRB check had been returned, but that a POVA first check would always be done. Such staff worked under close supervision until the CRB arrived. A new night care assistant confirmed she had been shadowing the staff as part of her induction training. The manager should be mindful that guidance from the Commission is that generally staff should not start until the full CRB has arrived at the home. When new staff started work, they did induction training in order to learn how to do their jobs safely. The manager had introduced “Skills for Care” induction training and had devised her own evidence booklet for staff to complete, so she could be sure they had understood the training. It included areas around support and respect, culture, diversity and values. A file for one of the newer carers held a completed booklet and another file showed that the first section had been duly completed. A new night care assistant, who had worked at the home for three weeks said she had not yet started her Skills for Care training. The manager said that before this was commenced, each new worker was given an induction pack containing relevant policies/procedures of the home so they could familiarise themselves before starting the Skills training. She was aware of the need to ensure that staff completed the training within the first 12 weeks of employment. As part of the training, staff were booked on external mandatory health and safety training courses or attended in-house training until a course became available. When new staff commence working at the home who have successfully completed NVQ level 2 training, this may be cross-referenced within the training records. Sections specific to the home should be fully completed, i.e., policies/procedures, aims/objectives and care practices. The manager said she would address this in future induction training. The manager was constantly searching for appropriate courses for staff to attend in order to further their training. One training shortfall was identified with regard to equality and diversity and the manager should make this her next training priority. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. An effective management team was in place ensuring that residents received a consistently high standard of care. EVIDENCE: The manager is a registered general nurse and had maintained her nursing status through continuing to undertake appropriate training. She had also completed the Registered Manager’s Award. She was extremely knowledgeable about the conditions and diseases associated with older age and also in respect of both strategic and financial planning. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 28 A deputy manager and assistant deputy, supported the manager. Both had recently completed their NVQ level 4 in care and were awaiting their certificates. It was clear they worked well together as a team and the manager gave excellent encouragement and support to them so they could progress in their chosen careers. She was familiar with the residents’ needs and had regular contact with their families, especially with regard to checking out their satisfaction with the service. It was evident from records seen and from speaking to staff that both the manager and deputy were extremely vigilant about monitoring care practices within the home. The manager often arrived at the home in a morning to be part of the night/day handover and this had happened on the day of the visit. Residents also spoke positively about the manager, with one person saying “She bends over backwards to help us”. Feedback from the staff about the manager was very positive with comments made such as “very approachable”, “understanding”, “she’s brilliant”, “gets involved with residents”, “we can go to her if we have any problems and she’ll give us advice” and “she mucks in when needed”. The day and night staff interviewed said they received regular one to one sessions, which they valued and supervision records confirmed that these were usually done every two months. Annual appraisals were also undertaken. The manager, deputy, assistant deputy and two senior carers had undertaken supervision training and a further two were booked on a course in May 2007. As well as achieving The Investors In People Award, which had been renewed in July 2005, the systems for resident consultation in this home were good. A variety of evidence was seen, which indicated that residents’ views were both sought and acted upon. Questionnaires were circulated to staff, residents and relatives which, when completed and returned, were collated and put into a format which showed the areas of strength and weaknesses of the home. Any comments or criticisms were addressed appropriately. Resident meetings were held, as well as meetings for the staff team. The staff interviewed felt their views were listened to, as did the residents who were spoken to. One resident said, “The manager likes us to get involved” and another said, “I go to resident meetings where they ask us things about what we want changed or what we like”. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 29 The manager had a quality assurance manual, which she had formulated herself, in order to assess where she felt the home was up to in respect of meeting the Commission for Social Care Inspection’s National Minimum Standards. As part of this process, she had sought the help of residents, relatives and district nurses. Where she had assessed the home was lacking, this was fed back to the appropriate staff and after a short period of time, the standard would be re-assessed. This initiative, together with spot check visits, medication audits and her commitment to good quality care, ensured that a continual cyclical monitoring system was in place. In addition to questionnaires, a newsletter was published which residents contributed to. One resident spoken to had valued being asked to contribute to it. Resident meetings were also now being held but the minutes were not seen as they were held on disk. Staff meetings were held for different groups, e.g., senior carers, night and day staff, and management and the minutes of the meetings showed that a wide variety of topics were discussed. Policies and procedures were regularly reviewed in the light of changing legislation and the home worked co-operatively with the CSCI to implement any identified shortfalls. Any requirements made in reports were always addressed within the given timescales. The majority of the residents living at Fieldhouse, relied upon their relatives to handle their financial affairs. Some relatives left money at the home for staff to give to individual residents as they needed it and receipts were in place where staff had purchased items on their behalf. Hairdressing and chiropody accounts were also in place. Personal monies for three residents were checked and found to be in order. The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place. In addition, the manager was aware of her responsibility to ensure that the staff team received all mandatory training with refresher courses being arranged as necessary. Information from the preinspection questionnaire showed that all staff had done moving/handling, all but two staff had done fire training, 12 had done first aid, 17 food hygiene and 12 infection control. Unfortunately, the Rochdale MBC training department had cancelled some courses that staff had been booked on. The manager had however, re-booked the courses. Training certificates were in place in the files inspected. However, the certificates were kept with supervision records, which were locked away. The manager agreed to transfer the certificates to the staff personnel file for future easy access. A fire risk assessment document was in place, which the fire department had approved. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 30 The pre-inspection questionnaire identified that maintenance checks were up to date. Random record sampling was undertaken of the servicing of lifts/ hoists, gas appliances and fire equipment. All were in order and any faults had been rectified. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 31 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 32 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. 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 OP7 OP9 OP30 Good Practice Recommendations The short term health care needs of the residents should be recorded on their care plans in order to make sure they receive the right care. The medication fridge should be maintained at a temperature between 2 and 8°C. The staff should receive training in equality and diversity so they will increase their knowledge and understanding of people from different cultures and backgrounds. Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Fieldhouse Care Home Limited DS0000042784.V298310.R01.S.doc Version 5.2 Page 34 - 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. 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