CARE HOMES FOR OLDER PEOPLE
Fieldside 9 Canadian Avenue Catford London SE6 3AU Lead Inspector
Kate Matson Unannounced Monday 27 June 2005, 10:45am
th 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 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 G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Fieldside Address 9 Canadian Avenue, Catford, London, SE6 3AU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8690 1215 020 8690 1215 Mr John R France Ms Gillian Amelia Hennell CRH Care Home 33 Category(ies) of DE Dementia registration, with number OP Old Age of places PD Physical Disability SI Sensory Impairment Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: This home is registered for 33 persons of whom up to 33 may be elderly, up to 15 may have dementia, up to 4 may have a physical disability and be over 65 years and up to 1 may have a physical disability and be under 65. To include 1 named person with sensory impairment. Date of last inspection 3RD November 2004 Brief Description of the Service: Fieldside is a privately owned care home registered for up to 33 older people, some with varying degrees of physical disabilities and mental health related problems. Fieldside is situated close to the shops and public transport facilities of Catford Bridge. The main part of the building is early Victorian and a large three-storey extension was added a few years ago. The accommodation consists of 31 single and one double bedroom with spacious communal areas. There are two passenger lifts so that people can have access to all internal areas. A large attractive garden with a patio is at the back, and at the front there is parking for visitors and staff. The home provides one respite care bed and at the time of this inspection there were three vacancies. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was conducted over 8 hours. The inspection included discussions with ten service users, four relatives, a visiting district nurse, the deputy manager and other staff, a tour of the premises and examination of care plans and other records. What the service does well: What has improved since the last inspection?
The home has taken steps to ensure that the wishes of service users in terms of illness or death are recorded so that they can be carried out. Risk assessments with particular attention to falls had been completed on all service users. The home had properly recorded a complaint as such, rather than as an incident as at the previous inspection. Generally service users and their relatives were confident that any complaints would be listened to and acted upon. The home had been assessed by an occupational therapist, and recommendations had been implemented to ensure that service users independence is maximised. The manager is competent and well respected and has commenced NVQ level 4 in Care as recommended by a previous inspection.
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 6 Service users financial interests are safeguarded and those service users who are supported in managing their money are given monthly balances of account. 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. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Although information given to service users has been improved it requires further detail to ensure service users can make an informed choice about where they live. Service users needs are assessed before moving into the home but continued efforts are needed to access information to inform and improve communication with service users. EVIDENCE: The statement of purpose and service users guide had been reviewed as required by previous inspections. They had been improved and included most of the required information. However some information was missing from the statement of purpose such as room sizes, emergency procedures, number of staff and whether nursing is provided and more detail was required in the service user guide. For example it states that arrangements for social activities and arrangements for service users to attend religious services are covered in the care plan, however details of opportunities should be provided in the information given to service users to help them make an informed choice about where they live. All of the service users files examined included an assessment completed by the senior staff before the service user’s admission to the home and a Care
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 9 Management assessment where they had been admitted following assessment by the local authority. However it was noted that information about service users past history was not available in some instances or was very scant. It is acknowledged that this information might not be always immediately available but continued efforts must be made to gain information about service users past lives in order to inform and improve communication with them. A life history book can be drawn up in conjunction with service users relatives and can be used as a therapeutic aid. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 11 Care plans are comprehensive but do not fully evidence service users involvement and monthly review. Personal care records were not all up to date and progress and care is not recorded on a daily basis. Service users healthcare needs are met. Medication systems are largely in order though some changes in recording are needed. The home deals with illness and dying with openness and sensitivity. EVIDENCE: The personal files of six service users were examined. The home uses a comprehensive care planning system and these generally evidenced that service users needs were assessed and reviewed monthly via a “dependency profile”. However as required at previous inspections this did not evidence a full care plan review had taken place and there were no signatures to evidence the involvement of the service user or their representative. Also some records of personal care were not up to date. It was also noted that records were not maintained on a daily basis to evidence the care that is provided. In accordance with the last inspection risk assessments with particular attention to falls had now been completed and were seen on all files examined. Records and service users files show that service users have access to a range of health professionals including, GP who visits weekly, district nurse, mental
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 11 health professionals, speech therapist, dentist, optician and chiropodist. The district nurse who was visiting on the day of the inspection was very positive about the home. She said that she has a good relationship with the staff and that if she is unable to visit straightaway when a referral is made, she is confident of the action staff will take prior to her visit. She also stated that the home works in partnership with the GP practice to take a proactive approach to healthcare and blood pressure checks are faxed through to the surgery as a matter of course. The homes medication stock and records were examined. These were generally in good order though it was noted that the application of some creams was not being consistently recorded as required at the last inspection. Also it was noted that correction fluid was being used rather than errors being corrected in ink as required. Also when medication was not given, including “as required” medication, “O” was recorded but the reason was not always recorded. It is not necessary to record when “as required” medication is not given, though guidelines must be available as to whether the person is able to request it or whether staff have to decide. Where prescribed medication is not given the reason must be recorded. The home has adopted an open and sensitive approach to death. When a service user dies a candle is lit near a photograph of the service user and service users are invited to join staff attending funerals. Care plans showed that service users had been consulted about their wishes regarding illness and death as required by previous inspections. Where service users lacked capacity, information had been sought from relatives and recorded in care plans. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 Service users are helped to exercise choice and control over their lives. Service users confirmed that they enjoyed their meals and they receive a good diet. EVIDENCE: All of the service users spoken to confirmed that they made their own decisions in all areas of their lives. They get up and go to bed when they choose, and choose how and where they want to spend their time. On the day of the inspection service users moved about the home freely, some chose to stay in their rooms. Service users are offered the key to their room and some were seen to lock their rooms. Service users stated that they are consulted at a monthly meeting about menu’s, activities and destinations for trips out. Some service users have assistance with their money and robust systems are in place to ensure that their rights are protected including monthly summaries of account. All of the service users gave very positive feedback about the food provided at the home. One service user said, “The food is out of this world, I wouldn’t eat this well at home.” One service user said, “Everything is fresh” and another said, “You get plenty, as much as you want”. They confirmed that there was always choice and one service user said, “They’ll always find something else for you if there’s something you don’t like.” Weekly menus seen at previous inspections indicate that the diet is varied, nutritious and appetising.
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their relatives were confident that any complaints would be listened to and acted upon. EVIDENCE: A previous complaint that had been recorded as an incident, had since been recorded in the complaints book as required by the previous inspection. There were no further complaints recorded. All but one of the service users stated they had never had to make a complaint but confirmed that they would if necessary. One service user said, “They’re always ready to listen”. One service user who had complained said it was resolved straightaway. Visitors also confirmed that they had no complaints or if they had complained these had been resolved satisfactorily. One service user’s relatives raised some minor complaints on the day of the inspection, but these had not been raised with the manager and they were advised to do so. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 and 26 The home offers a very pleasant environment for service users. It offers single bedroom accommodation, and adequate facilities and shared space. It is safe, clean, well maintained, and furnished to a high standard. It has been assessed by an occupational therapist though the practice of storing communal supplies of some personal items does not ensure that service users independence is maximised. EVIDENCE: The home offers a very pleasant environment for service users. It is a large converted Victorian house with a modern purpose built extension at the rear. There are 31 single rooms with one double room. There is a range of communal spaces including lounges, a dining room and a large garden at the rear of the property. The home is very well maintained and decorated. There are sufficient toilets and bathrooms available. An occupational therapy assessment has been completed as required by a previous inspection and all of the recommendations have been implemented to ensure that the homes environment and equipment are suitable for service users needs. It was noted
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 15 that incontinence pads were stored on open shelves in a downstairs bathroom and only one service user had a supply in their own room. Service users privacy and dignity must be protected and promoted by offering them their own supply of pads and by storing pads in a cupboard. The individual and shared space in the home is adequate. Service users rooms are equipped with good quality furnishings and service users had individualised their rooms with their own possessions. The home is clean and hygienic and there were no unpleasant odours. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 Recruitment practices had improved but there was a lack of some essential documentation to evidence that service users are fully protected. Staff are well qualified but there was a lack of evidence that induction and foundation training are delivered within the required timescales and to National Training Organisation specifications. EVIDENCE: Five staff files including those of two new staff were examined. There is a separate file of disclosures from the Criminal Records Bureau (CRB). Records indicated that in accordance with a previous inspection no new staff had commenced unsupervised employment in the home before references had been sought and a CRB check had been received, unless a check had been made against the list of people considered unsuitable to work with vulnerable adults. CRB checks had been done on all existing staff though it was noted that not all files included proof of identity and a photograph as required by regulation. Also not all existing staff had two written references in place. The deputy manager stated that these were members of staff who had worked at the home for a long time and it would not be possible to get references for now. As these staff were employed prior to the regulations being enforceable this is considered acceptable. It is good practice to ask for references to be submitted on headed paper or with a company stamp to verify authenticity. The home has a well-trained staff team, with all staff having completed or currently completing NVQ courses. However as at the last inspection it was noted that although induction training is to National Training Organisation (NTO) standards, it was not completed within six weeks of employment and there was no evidence that foundation training is to NTO specifications and
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 17 completed within six months. This must be addressed to ensure that staff are trained to fully meet the needs of service users. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 and 38 The home is well run and the manager is respected, competent and should hold the required qualifications within the set timescale. Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are protected though notifications practices do not fully promote this. EVIDENCE: Staff and service users were positive about the management of the home. One service user said, “They are special people, Gill is the right person for the job.” The Registered Manager has many years of experience in caring for older people. She has managed Fieldside for seven years and worked as officer in charge for six years before that. The manager has completed her NVQ level 4 in Management of Care and in accordance with a previous recommendation has commenced NVQ level 4 in Care. Service users are encouraged to manage their own money where possible to retain some independence. Service users who are unable to do this or who do not have relatives who are able to do this for them, are supported by the home
Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 19 to manage their money. There is a separate book for recording each service user’s financial transactions, and receipts are kept for these. Two staff signatures are required for each transaction and the record and money are checked weekly. In accordance with a previous inspection service users are given a monthly balance of their account held at the home and at the bank. The home has appropriate health and safety policies in place. Staff receive training on safe working practices. The environment is safe and appropriate checks of water temperatures, fire alarms, etc are completed. Gas, electrical installation, electrical appliance and fire alarms and equipment inspection and servicing certificates were seen to be up to date. Action had already been taken towards meeting requirements made by a recent fire inspection to be met by 7th September 2005. Although falls and accidents are recorded, the Commission is not notified of these in accordance with regulation. This must be rectified so that as well as falls and accidents being monitored internally by the home, they may also be monitored externally. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 2 3 3 x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x 3 x x 2 Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 and 5 Requirement The registered provider must ensure that the statement of purpose and service user guide are reviewed to include all of the information required under schedule 1 of the Care Homes Regulations and Standard 1 of the National Minimum Standards.(Timescale of 31/01/05 not met) The registered manager must ensure that information about service users past lives is sought and recorded in their care plans. The registered manager must ensure that care plans are dated and reviewed monthly. Where additional monitoring sheets are in use such as records of bathing or bed linen changes these must be kept up to date (Timescale of 31/01/05 not met) The registered manager must ensure that care plans evidence the involvement of service users or their representatives in the care planning and reviewing process. The registered manager must ensure that service users care and progress is recorded on a Timescale for action 31/10/05 2. 3 14 (1) (c) 31/10/05 3. 7 15 30/09/05 4. 7 15 31/10/05 5. 7 12 (1) (a) 31/10/05 Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 22 daily basis 6. 9 13 (2) The registered manager must ensure that all applications of creams and ointments are recorded on the MAR chart though it is acceptable for applications of aqueous creams and bath emollients to be recorded elsewhere for example on a separate record kept in the service users room or in the daily notes. (Timescale of 31/12/04 not met). The registered manager must ensure that where prescribed medication is not given, a reason is recorded. As required medication must only be recorded when given, though guidelines must be in place regarding whether the service user is able to ask for it or whether staff have to decide. The registered manager must ensure that any errors in medication recording are corrected in ink and correction fluid is not used. The registered manager must ensure that service users are offered personal supplies such as incontinence pads to be stored in their own room. The registered manager must ensure that all staff files include proof of identity and a recent photograph of the staff member The registered provider must ensure that the home’s induction and foundation training programme meets TOPSS standards, and ensure evidence is available to support this for future inspections.(Previous timescale of 31/03/05 not met) The registered provider must ensure that notice is given, 31/08/05 7. 9 13 (2) 31/10/05 8. 9 13 (2) 31/10/05 9. 22 12 (4) (a) 31/10/05 10. 29 19 (1) (b) 31/10/05 11. 30 18 (1) (c) (i) 31/10/05 12. 38 37 31/08/05 Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 23 without delay, of any occurence under this regulation including falls. 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 3 22 29 Good Practice Recommendations It is recommended that life history books are drawn up for each service user. It is recommended that additional cupboard space is provided in order to store communal supplies of a personal nature out of view. It is recommended that references be requested to be supplied on letter headed paper or with a company stamp to verify authenticity. Fieldside G52-G02 S25619 Fieldside V235246 270605 UIV Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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