Inspection on 16/02/06 for Fieldway

This inspection was carried out on 16th February 2006.

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

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

Other inspections for this house

Fieldway 04/06/07

Fieldway 26/10/06

Fieldway 22/09/05

Fieldway 02/11/04

Fieldway 12/05/04

Fieldway 10/12/03

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 Fieldway 40 Tramway Path Mitcham Surrey CR4 4SJ Lead Inspector Liz O’Reilley Unannounced Inspection 16th February 2006 10:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 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. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fieldway Address 40 Tramway Path Mitcham Surrey CR4 4SJ 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) 020 8648 3435 020 8648 3577 BUPA Care Homes (AKW) Ltd Mrs Isabella Mackenzie Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68), Physical disability (37) of places Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit two named service users under the age of 65 years. 22nd September 2005 Date of last inspection Brief Description of the Service: Fieldway Nursing and Residential Centre is a registered care home for sixty eight older people including thirty seven service users who may also have physical disabilities. The home has recently been acquired by BUPA Care Homes. The home is purpose built, with accommodation over two floors. Nursing care is provided on the ground floor with residential care on the first floor. All residents have their own single bedroom with en suite toilet facilities. Each floor has a dining room, a small kitchen and two lounges. Assisted bathrooms, shower rooms and toilets are provided on each floor. Two passenger lifts allow access to the first floor. Parking is available to the front of the building with gardens to the rear and one side of the home. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two regulation inspectors over four hours. During the course of this visit the inspectors had the opportunity to talk with ten residents, two visitors and staff. This home has recently been taken over by BUPA Care Homes and a number of operational issues are in the process of either being reviewed or changed in line with the new organisation. What the service does well: What has improved since the last inspection? Clear improvements have been made by staff on the management and recording of medication in the home. Staff have been provided with training on dementia care which assists in ensuring that the needs of residents will be understood and met. The record of food provided for each individual has been improved which allows for the monitoring of the diet of each resident. Staff are receiving regular supervision from a more senior member of staff which assists in ensuring that all staff are working in line with the aims and objectives of the home and are well supported. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 6 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. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 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 Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Residents are provided with information on the home through the Service User Guide and Statement of Purpose. These documents need to be reviewed. The pre admission assessments carried out for each person provides staff with information on the needs of residents. EVIDENCE: The Statement of Purpose and Service User Guide provide information to residents and prospective residents on what they can expect from the service. These documents need to be reviewed to take into account the recent change in ownership of the home. A copy of each up dated document needs to be provided to the CSCI. Pre admission assessments are carried out before anyone moves into the home. This is to ensure that the home can meet the needs of the individual and to provide information to staff on the needs and wishes of residents before they arrive in the home. Further work needs to be done to make sure that the information gained during the assessment is used to compile useful care plans. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Work needs to be done to make sure that every resident has a useful care plan. The health care needs of residents are met. Medication is well managed. The wishes of residents in relation to death or terminal care need to be sought and recorded. EVIDENCE: A sample of care plans were examined on each floor. On the ground floor, nursing unit care plans were seen to be in place and reviewed monthly. Evidence of the care plan being compiled in consultation with residents and or their representatives was in place. Individual risk assessments were seen to be available to staff. On the ground floor staff must ensure that where assessment indicates a risk of pressure sore development details of actions and equipment to be used are clearly recorded. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 10 Where moving and handling equipment is required clear information on the type of equipment and the size of slings needs to be clearly recorded. Where care needs indicate a fluid balance chart is required staff must ensure that these are fully completed and totalled at the end of twenty four hours. This will ensure that any lack of fluid over twenty four hours can be addressed. On the first floor care plans are inadequate. Each resident must be provided with an individualised care plan which addresses the full needs and wishes of each resident. Care plans must be compiled in consultation with the resident and or their representative and be reviewed on at least monthly or more frequently if required. All assessments must be signed and dated. Risk assessments must be reviewed on a regular basis. Generally care plans lacked information on the religious needs and wishes of individuals and staff clearly have problems in including issues about expressing sexuality and wishes regarding terminal care and death. In two instances there was no information on the social activities of individuals or their wishes on what they would like to do. It is of concern that requirements have been made following numerous inspections of the home regarding the provision of adequate care plans and little progress has been made within the residential unit. It is clear to the inspectors that staff are having difficulty in compiling care plans. The inspectors are aware that this home has relatively recently been taken over by a new organisation. The registered persons must take action to ensure that staff are provided with training on care planning. It is recommended that all care staff are provided with this training on person centred planning to allow for keyworkers to be fully involved in the care planning and review process. It was noted on the ground floor that information on the care plan regarding support with meal times and eating were not being followed It is also recommended that care plans are made more accessible to staff on a day to day basis so that they can become a working document. Arrangements are in place for residents to receive regular health care checks. Staff were seen to monitor the health of individuals and consult with other health care professionals if required. Staff were observed to respect the privacy of residents when providing direct care, offering assistance and support. Residents felt their privacy was respected by staff and that they were treated in a considerate manner. It was noted that a large white board on the first floor displayed all the names of those resident on the unit. This information needs to be removed from this public area. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 11 The recording of medication has improved since the last inspection of the home. Medication was seen to be well managed and safely stored. Where residents refuse medication staff keep GPs informed. The records of medication administered by staff were well maintained, up to date and accurate. A record of all medication received and returned to the pharmacy is kept. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,&15 Residents spoken to at this visit were happy with the activities on offer in the home. Further work needs to be done to ensure that the religious needs and wishes of residents are known and met. EVIDENCE: Information on the activities available in the home were seen to be on display on each unit. In addition activities staff remind residents on a daily basis about what activities are going on. Staff take into account the personal preferences of residents in relation to joining in activities by providing group and one to one sessions. Staff have recorded the social interests and wishes of residents in certain instances. The records were not consistent and in one instance no information had been recorded on the persons interests or on what activities they had participated in. Information on the religious needs and wishes of residents must be recorded along with how residents who wish to do so can attend religious services of their choice. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 13 As noted in previous inspection reports the provision of an appropriate vehicle for the home would assist in enabling residents to access community facilities and activities. Residents gave very positive comments on the food provided. A varied menu is available. Catering staff discuss with individual residents their preferences where they have particular needs. The menu provides a good variety of food and clear alternatives at each meal time. Improvements have been made in the records of food provided for each person. The inspectors observed one resident sitting asleep in their room with their main meal and their hot sweet in front of them. When the inspector approached the resident both courses were by then cold. The food was not presented as set out in the care plan. The registered persons must carry out a review of the way in which meals are organised and the time allocated, to ensure that staff are able to provide appropriate support and monitoring in a relaxed environment. Staff should not be providing residents with a second course before they have finished with their previous course. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The new complaints procedure was seen to be freely available in the home. EVIDENCE: The complaints procedure was seen to be available in the home. Staff were found to be well informed as to what action they should take should they be approached by anyone with a complaint. The procedure includes clear timescales for responding to any complaint and the contact details for the CSCI. The record of complaints was not available at the time of this inspection as the registered manager was not on duty. Senior staff reported that no complaints had been received by the home since the last inspection visit. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home is reasonably well maintained. However a number of areas are showing signs of wear and tear. The majority of the home was found to be clean and tidy. Further attention needs to be paid to the small kitchen areas on each unit. EVIDENCE: The majority of the home was seen to be adequately maintained. A number of areas are now in need of redecoration. Staff informed the inspectors that staff from the organisation had been to assess the condition of the building with a view to carrying out work. The small kitchen areas on each floor are in need of refurbishment and redecoration. It was noted that the flooring in these areas was difficult to clean and consideration should be given to taking the flooring up to skirting board level. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 16 A number of bathrooms are showing signs of wear and tear. The lounge area on the first floor nearest the staff station is in need of redecoration and refurbishment. There is damage to the ceiling in this room which needs urgent attention. On previous visits this room was not used by residents but it was noted that a number of residents were using this lounge at this time. The lay out of this room needs to be reconsidered to make it more homely. Most areas of the home were found to be clean and tidy. As noted previously the kitchen areas on the units need to be refurbished and the cleaning of these areas including flooring and cupboards needs to be monitored more closely. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Sufficient staff were seen to be available to meet the needs of the residents in the home at the time of this inspection. Staff are provided with opportunities to take part in training to improve and build on their knowledge and skills. Residents gave very positive comments on the staff group. EVIDENCE: Sufficient staff were seen to be on duty to meet the needs of the residents in the home at this visit. As noted previously the organisation of meal times needs to be reviewed. This review needs to include the number and the use of staff around these times. On the ground floor two qualified staff are available at all times. Eight carers are on duty in the morning, four carers in the afternoon and early evening and two carers at night. On the first floor five carers are available in the morning, four carers in the afternoon and early evening and two carers at night. One full time and one part time activities organiser are available in the home. The home employs separate cleaning, catering, laundry and administrative staff. A maintenance person is also employed. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 18 Eight carers are in the process of completing NVQ training. A number of carers have already completed this training. The numbers of staff with this qualification were not available at the time of this visit. The inspectors were informed that all staff had been provided with training on dementia care since the last inspection of the home. Staff stated that they had good opportunities for training to develop and increase their knowledge and skills. Staff felt that opportunities for training had improved since the new organisation had taken over the home. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 & 38 An annual review of the service needs to be carried out taking into account the views of residents and other stakeholders. Changes in the way money is held for individuals will benefit residents. Staff make regular checks on the home and equipment to ensure the health and safety of residents, staff and visitors. Two areas need further attention. All staff are now provided with regular one to one supervision. EVIDENCE: The registered manager was not on duty at the time of this inspection. The new organisation have not as yet completed a review of the service. The inspectors were informed that the company has in place quality assurance and monitoring systems and that a review would be completed. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 20 Facilities are available for residents to deposit small amounts of money with the home for safekeeping. At the time of this visit the administrative staff were in the process of transferring the cash held to individual personal allowance accounts which will provide individual interest on each account. This is an improvement on the arrangements in place under the previous organisation where no interest was accrued. Administrators were also in the process of going through all staff and residents files to ensure that all appropriate information is in place. The inspectors were informed that all staff are now being provided with one to one supervision on a regular basis. This will assist in ensuring that all staff are working towards the stated aims and objectives of the home, that the individual training needs of staff can be addressed and offer opportunities for staff to express any concerns they may have. Regular checks are carried out on the building and equipment to ensure that safety of residents, staff and visitors to the home. It was noted that the record of temperatures for the food fridges on the units were not up to date. The registered persons must ensure that regular checks are carried out on fridge temperatures and recorded. It was noted that Steradent was not being stored appropriately on the first floor. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 21 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 3 x 2 Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 22 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 OP1 Regulation 4&5 Requirement The Registered Persons must ensure that the Statement of Purpose and Service User Guide are updated. A copy of these documents must be provided to the CSCI. The Registered Persons must ensure that a care plan is in place for each resident. The Registered Persons must ensure that care planning for each individual includes information of the social, emotional and spiritual needs and wishes of residents with information on how these needs will be met. (timescale of 15/12/05 not met) The Registered Persons must ensure that all care plans are reviewed on a monthly basis or more frequently if required. (timescale of 01/11/06 not met) The Registered Persons must ensure that risk assessments are reviewed as part of the monthly care planning review. Timescale for action 01/08/06 2. 3. OP7 OP7 15 15 01/06/06 01/06/06 4. OP7 15 01/06/06 5. OP7 13 01/06/06 Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 23 6. OP7 13(4) 7. OP7 13(4) 8. 9. OP7 OP30OP7 12(1) 18(1)(c ) The Registered Persons must ensure that details of actions and equipment to be used for individuals at risk of pressure sores is recorded. The Registered Persons must ensure that where moving and handling equipment is required clear information on the type of equipment and size of sling to be used is recorded. The Registered Persons must ensure that fluid balance charts are fully completed. The Registered Persons must ensure that all staff are provided with training on care planning. The Registered Person must ensure that staff provide care and support in line with individual care plans. The Registered Persons must remove any information regarding individuals in the home from public areas. The Registered Persons must ensure that the wishes of residents in relation to actions to be taken after death are recorded and complied with. (timescales of 21/02/05 and 15/12/05 not met) The Registered Persons must carry out a review of the way in which mealtimes are organised. The Registered Persons must supply to the CSCI a copy of the redecorating/refurbishing plan for the home. The Registered Persons must ensure that the kitchen areas on each unit are kept clean and tidy including the floors and cupboards. 01/06/06 01/06/06 01/06/06 01/08/06 10. OP7 12(1) 01/06/06 11. OP10 12(4) 01/06/06 12. OP11 12(2) 01/06/06 13. 14 OP15 OP19 12 23(b)(d) 01/06/06 01/08/06 15 OP26 23(d) 01/06/06 Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 24 16 17 OP33 OP38 24 13(4) The Registered Persons must supply the CSCI with a copy of the annual review of the service. The Registered Persons must ensure that regular checks are made and recorded on the temperature of all refrigerators in the home. All substances that may be harmful must be stored appropriately. 01/08/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations It is recommended that all care staff are provided with training on person centred planning to enable care staff to compile care plans with the support of care coordinators. It is recommended that consideration should be given to the provision of an appropriate vehicle to enable resident to access community activities and facilities. Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fieldway DS0000019090.V285896.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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