Inspection on 01/04/08 for Fieldside

This inspection was carried out on 1st April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fieldside 12/06/07

Fieldside 07/07/06

Fieldside 06/03/06

Fieldside 27/06/05

Fieldside 03/11/04

Fieldside 08/06/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Fieldside 9 Canadian Avenue Catford London SE6 3AU Lead Inspector David Lacey Key Unannounced Inspection 1-2 April 2008 10:30 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 Fieldside DS0000025619.V361270.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. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fieldside Address 9 Canadian Avenue Catford London SE6 3AU 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) 0208 690 1215 0208 6905883 gillhennelll@parksidecare.org.uk Mr John R France Mrs V France Ms Gillian Amelia Hennell Care Home 33 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (33), Physical disability (33) of places Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 33 12th June 2007 Date of last inspection Brief Description of the Service: Fieldside is a privately owned care home registered for up to 33 older people with dementia, some with varying degrees of physical disabilities. The home also takes people for respite stays. Fieldside is situated close to the shops and public transport facilities of Catford Bridge. The main part of the building is Victorian and a large three-storey extension has been added in recent years. The accommodation consists of single bedrooms and spacious communal areas. There are two lifts so that people can have access to all internal areas. The home has a large back garden with a patio, which is fully accessible. At the front there is parking for visitors and staff. As at April 2008, the fees are £465 - £503.50 per week. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars, which means that people using the service receive a good service. This key inspection included an unannounced visit to the care home, which took place over two consecutive days. To gain the views of people living in the home, I spoke with ten residents, a relative and two care professionals visiting the home. During the visit, I met with the registered manager, the provider and four members of the home’s staff. I sampled documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures. The care home had already provided us with its annual quality assurance assessment (AQAA) when we asked for it. This self-assessment document focuses on how outcomes are being met for residents and also gives us some numerical information. Before the visit took place, we had surveyed a sample of the home’s residents and their relatives, carers and advocates. Their responses have also been taken into account. What the service does well: Residents have a clean, tidy and well-maintained environment in which to live. Residents are satisfied with the way their home is kept and a regular visitor also commented positively about the cleanliness of the home. Care delivery is organised and monitored well by the senior staff team. Staff members respect residents’ privacy and dignity. The home ensures that its residents have good access to local health care services to meet their identified needs. The home employs suitably qualified and competent staff to meet residents’ needs. Different activities are offered to residents, which helps to give them stimulation and enhance their wellbeing. Staff are also good at supporting residents to maintain contact with their families and friends. One relative responding to our survey stated the home does everything well, that their relative who lives in the home is happy, well dressed and eating well. Another relative thought the standard of food and the general care of residents was good, and that staff are always friendly and helpful. Fieldside DS0000025619.V361270.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. The summary of this inspection report can be made available in other formats on request. Fieldside DS0000025619.V361270.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 Fieldside DS0000025619.V361270.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have the information they need to make a choice about whether to move into the home. Prospective residents are assessed to ensure the home can meet their needs. The home does not offer intermediate care. EVIDENCE: The home has a statement of purpose and service user guide. These were available in the home during the inspection visit and supplied to residents and families as needed. Prospective residents and their representatives are encouraged to visit the home before making a decision to move in. Five of the respondents to our survey stated they had received enough information about the home before moving in so they could decide if it was the right place for them. The one respondent who had not received enough information commented, “Very quick work on the whole situation, it was the first place they suggested”. Two relatives we surveyed said they had received enough Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 9 information about the home to help them and their relatives to make decisions. One relative told us s/he did not deal with the initial arrangements for her relative to move into the home. Needs assessments were seen in residents’ files. Residents I met with whose placement had been arranged through a local authority had received care management assessments and most had been reviewed. While I was in the home, a social worker visited to undertake a review, meeting with the resident and a relative. The manager said she or another senior member of staff also carry out their own pre-admission assessments to make sure the home can meet a potential resident’s needs. The home had confirmed to us in its annual quality assurance assessment (AQAA) that all residents who are privately funded have contracts. The home has a block contract with the local council (Lewisham), and the majority of its residents have had their placements arranged under this agreement. The registered provider met with me during the inspection visit and confirmed that contracts are held elsewhere. The provider confirmed residents’ contracts with statements of terms and conditions could be brought to Fieldside for inspection as required. Residents who responded to our survey either stated they had received a contract or that they could not remember whether they had received one. Fieldside does not offer intermediate care, thus standard 6 does not apply. Fieldside DS0000025619.V361270.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. 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 care needs are met and residents are satisfied with the care they receive. Care delivery is well organised. Care records have improved though it needs to be always evident that all aspects of a resident’s care have been kept under regular review and that residents are being consulted about their care. The home ensures its residents have ready access to health and social care services. Residents are treated with respect and their privacy upheld. Medicine administration is generally satisfactory, though some improvements are still needed. Residents at the time of death and their families are supported well. EVIDENCE: Observation and discussion during the inspection showed that care delivery was being organised and monitored well by the manager and her deputy. Care practices seen were good and residents and their relatives were positive about the care they receive. Four of the residents who responded to our survey stated they always receive the care and support they need, including medical Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 11 support. Two residents stated this is usually the case. A resident commented, “this is my home and I rely on the staff to look after me”. Another stated, “I always get the medical help I need all the time”. Two relatives we surveyed felt the care home always meets their relatives’ needs, meets other residents’ different needs, and that the home provides the support or care to their relatives that they expected. A visitor I met during the inspection said his relative is looked after well, her needs are met and she is happy living in the home. Residents I met during the inspection visit were well groomed, with hair tidy and nails clean and trimmed. They were dressed appropriately for the time of year, and those I spoke with said they had enough clothing. Residents who I met with in their bedrooms had call bells and fluids at hand. The home makes sure that residents have access to specialist health care services as they need. For example, a podiatrist from the local health service was visiting the home during the inspection. She was providing foot care to a resident with diabetes whose care I was case-tracking as part of my inspection. Staff from the home had supported the same resident to attend the hospital diabetic clinic the previous day. The resident told me she gets looked after very well. Other health care services that residents had received included optical and dental services. With regard to a previous requirement to seek professional continence advice when needed, the manager explained the continence advice service is no longer available. When staff need specialist advice about residents’ continence issues, the home obtains this from the visiting GP and district nurse. Staff I spoke with told me about how they try to promote residents’ continence, for example, by regular prompting and providing assistance with toileting when needed. The home liaises well with local social services, for example in relation to care reviews, which benefits residents. A social worker was visiting during this inspection to carry out a review of a resident who had moved into the home recently. The social worker had been visiting the home regularly for some years and described it to me as “a good home”. The social worker said the care is good, the environment is nice for the residents, and that the home works well with social services when a resident develops nursing needs and has to move on to a different placement. The manager said she and her staff had been working to improve the quality of care records and risk assessments, following issues raised at the last inspection. I examined care plans and supporting documentation for those residents being case-tracked. Each had a care plan in place but the plans varied in quality, not always reflecting the quality of care I heard about or saw being provided. Plans gave brief guidance to staff about meeting residents’ needs but it was not always evident they had been reviewed regularly or that Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 12 whenever possible residents or their representatives were being consulted about their care (requirements 1 and 2). Following a previous requirement, risk assessments had been completed on care documentation that I saw. For example, the residents whose care I looked at had varying needs in terms of their mobility. Some were fully mobile, whereas others needed some help such as a walking aid or assistance from staff to get in and out of a chair. The residents had mobility assessments on their care plans but it was not always evident these had been kept under review. One resident’s mobility needs had changed and she had had falls. The care plan gave some guidance to staff on how to meet her current needs but the most recent recorded assessment for moving and handling was dated 2004. The manager and deputy were aware of the circumstances in which a resident would need to be considered for a nursing placement because of mobility needs. The home had changed some of its procedures for medicine administration since the previous inspection. The manager stated in the home’s selfassessment and confirmed at the inspection visit that these changes had improved the home’s handling of medicines and meant there was less potential for error. For example, the monitored dosage system (Venalink) from the supplying pharmacist now covers a month rather than the previous weekly arrangement. The medicine administration records (MAR) I sampled for inspection were complete with no unexplained gaps. Medication administration is recorded as each person takes his or her medication, which has addressed the potential for error noted at the previous inspection. Residents told me they get the right medication at the correct times. Staff confirmed they have to complete relevant training before they can give medication to residents. There were some aspects of medication administration that needed improvement. A resident was being prescribed a controlled drug (CD) and a MAR was being used to record both the amount received and the administration of this drug. A running total of the stock remaining was not being recorded. This was not safe practice as it could not be determined whether the stock held tallied with the record of administration. I raised this with the manager who said they had not had a resident on a CD before. She found an unused CD register in the staff office and took immediate action to ensure this was put into use. Staff must be fully aware of requirements for handling CDs, even though this is a rare occurrence in this home, and I have made a requirement to support the manager’s action (requirement 3). I have also recommended the home obtains and consults the Royal Pharmaceutical Society’s published guidance about medication administration in care homes (recommendation 1). The CD was being stored in a lockable tin placed in the drug cupboard. To comply with recent legislative change, the home must obtain a proper CD cupboard (requirement 4). There were creams being stored on the same shelf as an oral medication, and I asked that, on safety grounds, internal and external medications are always stored separately Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 13 (recommendation 2). I have also recommended that two staff sign handwritten changes on MARs, to minimise the possibility of errors occurring (recommendation 3). There are procedures to ensure residents can be supported to spend their final days in the home, if that is their choice. From discussions, it was apparent that staff members treat residents and their families with care and respect at the time of death, including with sensitivity to particular religious or cultural needs. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. In general, residents are supported to follow their individual life styles, retaining choice and control over their lives. However, residents are not always assumed to have capacity to make specific decisions unless determined otherwise. Residents can choose to take part in various activities. The home supports its residents to maintain contact with their families and friends. Residents are given a balanced and nutritious diet. EVIDENCE: There was a calm, relaxed atmosphere in the home when I arrived for the unannounced visit. Residents were either in the lounge or their rooms. Residents made positive comments about their lives in the home. For example, one commented, “This is my home and I appreciate it because I myself have worked in homes in my days and I know what it’s like to be old”. Another respondent to our survey stated, “I am very happy to live here, I couldn’t ask for more”. Responses to our survey of relatives were that the home supports its residents to live the life they choose. Residents’ choices in relation to their care are supported. For example, a resident responding to our survey commented, “I look after myself which I prefer”. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 15 There was a programme of planned activities on display and it was understood events such as barbeques and trips out are organised, mostly in the summer months. During the visit, I saw an activities session for a group of residents taking place in the large garden room. An activities coordinator led the session, which involved singing and moving to ‘old-time’ music. The residents taking part in the session were clearly enjoying this activity, including a resident whose care plan notes s/he is not usually interested in joining in organised activities. Four of the residents who responded to our survey stated there are always activities arranged by the home that they can take part in. One resident said this is usually the case and another stated that there are sometimes such activities available. A resident commented that, “I often choose not to get involved, like my own space”. Following a previous requirement, activities sessions are being organised as far as possible to meet the individual needs of residents, recognising that their interests and capacities will differ. It was evident from discussion with the manager and from documentation that staff recognise organised group activities are not suitable for everyone, and that an individual approach is needed. Residents’ interests were included in care plans I saw and some residents’ participation in activities was being recorded in a book in the office. Visitors are welcomed at any reasonable time. Responses to our survey of relatives confirmed the home helps its residents when necessary to keep in touch with their relatives. The survey also showed people are kept up to date with any important issues affecting residents they visit. The home’s self-assessment provided to us before the inspection spoke about how the home is good at allowing residents to have control over their lives and exercise choice. As mentioned above, this was borne out by our survey. For the most part, it was also evident during my visit but there was an incident that showed the home must take care to ensure this is always the case (requirement 5). A resident was trying to open the door to his room, which was locked. He did not have a key. When I enquired about this, it transpired a decision had been made by the home to keep his room locked during the day and not offer him a key as there had been occasions when he had shown challenging behaviour such as emptying out the contents of drawers and cupboards. There was no evidence in the care records that this decision had been made in his best interests, following consultation, nor evidence that there had been determination of specific incapacity. I raised this with the manager, drawing her attention to relevant legislation about mental capacity. It is positively noted she began taking immediate action to begin a process of consultation involving the multi-professional team in the first instance. The home’s self-assessment had told us they had been using the views of residents to improve mealtimes, for example by changing seating arrangements. Lunch on both days of my visit was relaxed and unhurried. Staff offered discreet and sensitive support, such as cutting food, but also Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 16 encouraged residents’ independence with feeding. The food was well presented and residents said the meals were tasty. Water was served during the meal. Residents who were able to give their views said they were enjoying their lunch and were positive about the food provided at the home. Five of the residents who responded to our survey stated they always like the meals that are provided. One stated s/he sometimes liked the meals. Comments we received included “good food” and “they are nice meals and if I was living at home I couldn’t cook for myself”. The food served matched what was on the menu. Residents have a nutritious and appetising menu, and a good variety of fresh produce is used. The home operates a ‘rolling menu’ over four weeks and was just about to change from its winter to summer menus. Choices of food were readily available on request but not shown on the menu (requirement 6). The manager said when the choices had been shown on the menu in the past, people had forgotten the next day what they had ordered and wanted something else. It is important that residents and their families know there is a choice of meals on request, so I discussed with the manager including such a statement on the menus in future. Because there are frequent admissions to the home that include people coming for respite stays and because people’s tastes change, it needs to be clear there is a choice of food available. Residents whose care I case tracked had received basic nutritional assessments. Records of food intake were sporadic but it was evident staff are aware whether people are eating and drinking as usual. The kitchen staff have written information about those residents who need special diets and information about individual food preferences. It appeared that residents’ dietary needs and preferences were being met. For example, two residents are vegetarian and the chef prepared alternative meals for them. However, the records of food provided did not indicate when there had been changes to the menu or when people had chosen alternatives to the menu. Staff agreed to improve this recording (requirement 7). Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that any concerns or complaints they raise will be taken seriously and dealt with appropriately. The home has policies and procedures for complaints and for safeguarding adults. Staff receive training and know about protecting residents from abuse. EVIDENCE: The home has an appropriate complaints policy and procedure, which is included in its service user guide. The commission has not received any complaints about the home since the last inspection. Information provided to the commission by the home showed that three complaints had been received within the past twelve months, which had been resolved within the timescales set out in the home’s procedure. This information was followed up during the inspection visit. It was evident each matter had been properly recorded and investigated, with two of the issues having been addressed by social services under their safeguarding procedures and subsequently closed off. The home’s self-assessment document told us about an open culture within the home so that resident can speak freely without fear of repercussions and can come to the office as they wish to speak in confidence. This information was supported by responses to our survey of residents and relatives. During my visit, I saw residents walking in to the office to speak with the manager or her deputy, and speaking to them elsewhere in the home. The self-assessment document also told us that the home had used people’s views to improve how Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 18 residents are made aware about the complaints procedure and the manager’s open-door policy. All the residents who responded to our survey confirmed they knew how to make a complaint and residents knew who to speak to if they were not happy. Two commented that if they are not happy about something they go to the office and speak with the manager or whoever else is in charge of the home at the time. Another said she speaks with staff if there is something she wants to talk about. One resident commented, “I’ve got nothing to say because I’m happy here and if I wasn’t I’ll talk to someone”. Two of the three relatives who responded to our survey stated they knew how to make a complaint. Two confirmed the home had always responded appropriately if either they or their relative had raised concerns about their care. Policies and procedures about safeguarding vulnerable adults were appropriate but were located in different files and there were a number of different documents. I recommended these be made easily available to staff, combining documents if necessary. At the same time, the policy statement about whistle blowing should be strengthened, to give staff added reassurance that they are protected by legislation (recommendation 4). The home’s self-assessment information stated that all staff had attended training in the protection of vulnerable adults, and that the home actively promotes whistle blowing and the protection of residents from abuse. I spoke with staff members who had received training in safeguarding adults. They understood how to raise any concerns they might have about residents’ safety and welfare. During my visit, there were signs of wellbeing amongst residents, who appeared comfortable and relaxed when interacting with managers and other members of the staff team. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 19 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, 20, 21, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, comfortable and well maintained. Staff use infection control practices but the home could still improve in this respect. EVIDENCE: The home is comfortable and homely. It has been adapted and extended to meet residents’ needs. There is ample communal space of a good standard, including a conservatory that looks over a pleasant back garden. The home has satisfactory provision of communal toilets, showers and assisted baths. All residents have single bedrooms. All bedrooms have a wash hand-basin, and one has en-suite facilities. The bedrooms that I saw were comfortably furnished, and most were personalised with the resident’s own possessions, family photographs or pictures. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 20 Over the two days of my visit, the areas of the home that I saw were clean and tidy, with no odour. There is an on-going programme of redecoration. Of the residents who responded to our survey, five confirmed the home is always fresh and clean. One resident stated this is usually the case. Comments we received included, “This home is spotless” and that the home is “always clean and tidy”. A relative stated the home was sometimes fresh and clean, commenting that s/he had needed to clean her/his relative’s room on one occasion. The manager explained the method of carpet cleaning has been improved since the previous inspection. The home’s self-assessment confirmed Fieldside has an infection control policy and that staff have received training to enable them to use good infection control practices. An improvement that needs to be made is for staff to wear blue aprons while assisting residents during mealtimes. This is especially important as care staff on rotating duties in the laundry are still needed to help at meal times and are not wearing protective clothing while doing so. I raised this with the manager who agreed to take appropriate action (requirement 8). At the previous inspection, it was noted the home had partly met a requirement to improve the laundry facility. There had been no further progress in this respect (requirement 9) but the registered manager told me the provider is considering a longer-term solution by moving the laundry to a separate external building to be erected in the grounds of the home. I met with carers who also undertake laundry duties. The laundry was operating effectively, with all machines working. The two washing machines were new. The carers understood basic infection control principles and told me how they deal with soiled laundry, to prevent cross-infection. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and competent staff are employed to meet residents’ needs. Staff are supported to undertake training that is relevant to their work and benefits residents. There are appropriate recruitment procedures, which must always be carried out to ensure they support and protect residents. EVIDENCE: When I visited the home, there were enough staff on duty to meet the needs of the thirty people in residence. From discussions and from examination of the staff rotas, appropriate staffing levels were being maintained. Staff members confirmed they have sufficient time off to rest between shifts, including breaks during a long day shift. My observations while case tracking a sample of residents showed their needs were being met promptly. Staff members were busy but did not appear unduly stretched. They were working well as a team. A resident said that staff were always prompt in giving attention, she just has to ring her call alarm. Residents we surveyed told us that staff are either always or usually available when they need them. One commented, “the staff are marvellous and kind, I couldn’t be in a better place.” Responses we received from two relatives were that staff have the right skills and experience to look after people properly. During the inspection visit, I saw staff members addressing residents respectfully and attending to them promptly. On several occasions, I saw staff Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 22 anticipating a resident’s needs, because through observation they had developed understanding of the resident’s behaviour. I saw a staff member using signing to enable effective communication with a resident who has sensory impairment. Five of the residents who responded to our survey stated the staff listen and act on what they say. A resident commented, “they always listen to what I have to say all the time and the carers help me a lot”. One resident wrote, “In general I like the home but sometimes wish staff would listen to me a little more”. I met with this resident during my visit and received only positive comments about the home and its staff. Care staff turnover over the last year has been low, with only one part-time carer leaving. The home’s self-assessment showed that all care staff are females, also that the home has nine male residents. At the inspection, the manager stated this was because no males had applied for posts. She stated the residents, including males, normally prefer female staff to provide their care. I saw a male resident’s care plan, which recorded “has no problem being cared for by member of opposite sex”. None of the male residents I spoke with made any comment about the gender of their carers. The home has a policy entitled ‘cross-gender care’, which states the home’s equal opportunities policy will be followed in employing male and female carers. The policy also states if there is a request for a same-sex carer, the home will fulfil this if the staff are available on duty. Staff members I spoke with outlined the recruitment and selection process they had undergone before taking up their posts. They said this had included an interview, references and Criminal Records Bureau (CRB) checks. I examined a sample of three staff files, two of which contained the necessary recruitment information. The third contained most of this information but the photocopied CRB disclosure on file for this staff member was incomplete, with part of the information missing (requirement 10). The manager was unable to locate either the full disclosure or confirmation it had been satisfactory but stated she would ask the staff member to bring in the original CRB or, if this is no longer available, ask the staff member to obtain a new disclosure. Staff were either undertaking or had completed NVQ programmes. A commendably high proportion of the home’s staff have at least NVQ at level 2. Two carers were starting NVQ level 2. Some staff members I spoke with gave examples of how they applied training in their practice and confirmed they are able to discuss any training needs with the managers. Discussion with staff members and scrutiny of the home’s self-assessment and staff personnel files showed that staff had completed training such as food hygiene, first aid, fire safety, infection control and manual handling. Adult protection awareness is considered a training priority and some staff had undertaken dementia training. I discussed with the manager that the recording of induction training could be improved, for example, making sure the carer and instructor sign and date each element to confirm satisfactory completion (recommendation 5). Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager is experienced and has the appropriate skills to run the home. The home communicates well with residents and their representatives, though needs to offer more information about how their views are being taken into account in the running of the home. The health and safety of residents, staff and visitors is promoted. EVIDENCE: The manager has been running the home for many years and is supported by a deputy manager. The manager is registered with the CSCI. Both the manager and her deputy have completed the Registered Manager’s Award and NVQ4 in care. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 24 Through observation and discussions during my visit, it was evident that the home is managed in an open and supportive manner. The views of residents, relatives and staff had been sought as part of the home’s monitoring of the quality of care that it provides. Staff members contribute their views both informally and also at staff meetings. Residents and relatives had provided their views through satisfaction questionnaires and at residents’ and relatives’ meetings. The returned questionnaires and the meeting minutes were available for inspection but the findings had not yet been collated into a report that could be made available for residents and relatives to read. Thus, a previous requirement in this respect had been met in part only (requirement 11). Until recently, the commission has been supplied with reports of the provider’s monthly visits to the home. I raised this with the provider during my visit. He said he spends much time in the home, normally visiting two or three days each week, and felt the reports were becoming a ‘paper exercise’. Residents and their relatives benefit from the reassurance of knowing the provider monitors the home and it was agreed he would continue to compile monthly reports and retain them in the home. It was evident the home’s procedures for assisting residents to manage their money were being followed. These procedures make sure residents’ financial interests are protected but also enable residents to choose to keep control over their finances as much as possible. Some residents manage their money without needing the home’s assistance and others prefer to rely on their families for help in this respect. Staff members I met with were receiving regular supervision and had ready access to senior staff for advice and support as they needed. Supervision still tends to focus on practical tasks but, from my discussions, is beginning to enable staff and their supervisors to look at other areas, such as staff training and development needs. This is in line with a recommendation from the previous inspection. The home promotes the health and safety of its residents, staff and visitors. The home’s self-assessment information outlined measures taken to address issues such as fire safety checks and staff fire training, and food hygiene. A follow-up visit to the home in October 2007 by the local council’s environmental health department confirmed all requirements from its May 2007 inspection had been met. During my visit, I checked a sample of hot water outlets and found them to be comfortable to my touch. It was evident the outlets are checked regularly to ensure residents’ safety. A previous requirement relating to health and safety had been met. Accidents to residents had been recorded and reported, and potentially hazardous substances such as cleaning fluids were being stored securely. The kitchen had been deep cleaned. The selection of health and safety documentation I examined was mostly up to date and within the appropriate timeframes. An exception was the electrical installation certificate, which was not available for inspection (requirement Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 25 12). The manager has confirmed the provider will make this available so it is evident this aspect of health and safety has been properly addressed. Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 26 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 27 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 Requirement The registered person must ensure that care plans are reviewed and the review recorded in sufficient detail. The registered person must ensure it is made evident that, whenever practicable, residents or their representatives are consulted when drawing up or reviewing their care plans. The registered person must ensure the home’s controlled drug (CD) register is used when a resident is prescribed a CD. The registered person must obtain a proper controlled drug (CD) cupboard for use in the home. The registered person must ensure that residents are always assumed to have capacity to exercise choice and control, unless it has been determined otherwise in specific instance(s). The registered person must ensure that there is a menu offering a choice of meals. Previous requirement. Choice is available but not shown on the DS0000025619.V361270.R01.S.doc Timescale for action 30/04/08 2 OP7 15 30/04/08 3 OP9 13 30/04/08 4 OP9 13 30/06/08 5 OP14 12 30/04/08 6 OP15 12 30/04/08 Fieldside Version 5.2 Page 28 7 OP15 17 Sch4 8 OP26 16 9 OP26 13 16 10 OP29 19 Sch2 11 OP33 24 12 OP38 13 menu. The registered person must ensure that records of the food provided are kept in sufficient detail. The registered person must ensure that staff wear appropriate protective aprons when handling and serving food. The registered person must ensure that the laundry walls are cleanable and the floor impermeable. Previous requirement – met in part only. The floor is now suitable but the requirement still stands in relation to the walls. The registered person must ensure it is evident that a satisfactory CRB disclosure has been obtained for each staff member before they begin work in the home. The registered person must ensure that they implement an annual development plan and publish an annual report on the quality monitoring they undertake. Previous requirement – met in part only. There is now a development plan but as yet no quality report. The registered person must ensure it is evident the fixed electrical installation has been tested and certified by a competent person at least every five years. 30/04/08 30/04/08 30/06/08 30/04/08 31/05/08 31/05/08 Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP9 Good Practice Recommendations The registered person should obtain and use a copy of the Royal Pharmaceutical Society’s guidance for medicine administration in care homes. The registered person should ensure that internal and external medications are always stored separately. The registered person should ensure that two staff sign handwritten changes on medicine administration records. The registered person should strengthen the home’s whistle blowing policy by adding reference to relevant legislation, specifically, the Public Interest Disclosure Act. The registered person should ensure the carer and instructor sign and date each element of an induction programme to confirm satisfactory completion. 2 3 4 OP9 OP9 OP18 5 OP30 Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Fieldside DS0000025619.V361270.R01.S.doc Version 5.2 Page 31 - 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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