Inspection on 22/09/05 for Fieldway

This inspection was carried out on 22nd September 2005.

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 16/02/06

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`Reilly Unannounced Inspection 22nd September 2005 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 Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 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.V253476.R01.S.doc Version 5.0 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 ANS Homes Limited 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.V253476.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named male service user aged 63 years. Date of last inspection 2nd November 2004 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. 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 are 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.V253476.R01.S.doc Version 5.0 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 on 22nd September 2005 over six hours. The inspectors had the opportunity to speak with sixteen residents, six staff, two visitors to the home and the registered manager. A sample of records were examined. What the service does well: What has improved since the last inspection? Since the last inspection of the home residents have benefited from an improved menu with more choice available. Staff have improved their record keeping in relation to the food which makes sure that individuals are provided with a balanced diet. There has been an improvement in the information available on moving and handling equipment to be used for individuals which assists in ensuring the health and safety of residents and staff. There have been less changes in the staff group which has provided residents with more continuity of care and opportunities to develop better relationships with staff. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 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.V253476.R01.S.doc Version 5.0 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.V253476.R01.S.doc Version 5.0 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 & 4 The home has in place a Statement of Purpose and Service User Guide which provides information on the service to prospective residents. An assessment of individual needs is carried out for each person prior to admission to the home to ensure that staff have up to date information. EVIDENCE: The home has in place a Statement of Purpose and Service User Guide which gives information for prospective and present residents on the service. These documents will need to be reviewed to include information on the new home owners. Once updated a copy of each document must be supplied to the Commission. In order to ensure that staff are aware of the needs of each person prior to moving in the home receive a copy of the Care Management assessment and staff from the home also carry out their own assessment. Since the last inspection the range of meals on the menu has been improved to reflect the cultural diversity of the resident group. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 9 In order to fully ensure that the needs of individual residents are met all staff need to receive on going training on caring for people with dementia to the appropriate level. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 11 Further work needs to be carried out on care planning to ensure that the social, emotional and physical needs and wishes of each individual are met. Staff must complete risk assessments and produce a full care plan for new residents to the home within set timescales. The healthcare needs of residents are met. The home ensures the health and welfare of residents in relation to medication. Further work needs to be carried out to ensure that the wishes of residents in relation to terminal care and death are sought and met. EVIDENCE: Each resident is provided with an individual care plan. The inspector looked at a sample of care plans on the residential and nursing units of the home. On the residential unit care plans were found to be standardised covering personal care and the risk of falls. Care plans are produced by one member of staff on the residential unit. In order to further develop care planning to ensure that the full needs and wishes of individuals are met it is recommended that staff training is provided for all care staff to enable keyworkers to produce care plans with support from the care coordinator. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 11 The information available on personal care was seen to provide good details for staff. It was noted that the daily notes for one resident indicated changes in relation to moving and handling but this was not reflected in the care plan. Care plans need to be reviewed on a monthly basis or more frequently should the needs of an individual resident change. The care plans seen on the nursing unit covered a wider range of physical needs and provided good information on how these needs were to be met. Good information was seen to be available on some of the personal preferences of individuals. It was noted that staff involved in activities in the home had contributed to the care plan in some instances. In order to ensure that the social needs and wishes or residents are met this information must be incorporated in all care plans. Residents had signed a care plan agreement in most instances. The registered persons should ensure that all care plans are compiled in consultation with the resident or if appropriate their representatives with evidence of this consultation on file. Consideration should be give to a formal review of the care plan for each individual at least annually whereby residents can have the opportunity to discuss their care and agree any changes. It was noted that on the nursing unit daily records in a significant number of instances stated “care needs met”. The registered persons must ensure that any record of the care provided gives clear information on the nature of the care and any outcomes. The healthcare needs of resident were seen to be met. All residents are registered with local GP practices, arrangements are in place for regular dental, optical and chiropody care. Staff consult with appropriate health care specialists as required and residents are supported to attend health care appointments. The health and welfare or residents is protected by good management systems for the administration and storage of medication. Medication records were seen to be well maintained. Appropriate action is taken should any resident decline to take prescribed medication. Risk assessments are carried out for any resident who is self medicating. In order to ensure that the wishes of residents in relation to terminal care and actions to be taken following their death can be adhered to staff must seek the views of residents or if appropriate their representatives. It is recommended that this information is sought prior to admission or on admission. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 A variety of activities are available in the home however further work needs to be done to ensure that these meet the individual needs of the residents. The lack of readily available reliable transport restricts opportunities for external activities. Further work needs to be done to ensure the religious needs of residents are met. Residents’ visitors felt welcome in the home. The menu shows residents are offered a balanced diet with clear choices available at each meal time. EVIDENCE: Two activities staff are employed in the home. A programme of activities was seen to be on display. The activities seen to be offered on the programme on the first floor did not evidence varied options. However during this visit staff were observed to be supporting residents to play cards in the garden and providing manicures. It was clear that staff engage in some one to one work with individuals. As noted previously the social needs and wishes of individual residents must be included in all care plans. This information will assist staff in tailoring the activities to meet the needs of the residents and provide evidence of their work. Two residents stated they would like to attend church occasionally. The care plans seen at this visit recorded the religion of residents but did not supply Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 13 information as to whether residents wished to practice their religion or how they wished to do so. Staff should investigate how the spiritual needs of individual residents can be met. It was suggested that there may be some difficulty in meeting the needs of a resident who wishes to attend a religious service outside the home. Should the home be unable to provide support or make arrangements for residents to attend services this must be clearly stated in the information supplied to all prospective residents. Residents can have visitors at any time and visitors stated they felt welcome in the home. The majority of residents spoken to were satisfied with the food provided. The menu provided offers clear choices at each meal time including food which reflects the cultural diversity of the resident group. Three choices are available on the menu at the main meal of the day with a further selection of alternatives available. Residents can get snacks and drinks at any time. Four of the sixteen residents spoken to felt the choices available were not to their individual taste. One resident stated that they felt they did not get sufficient to eat at breakfast time. The manager informed the inspectors that this would be addressed and the resident would be offered more. To ensure that residents receive a well balanced diet the home retains a record of meals provided to each individual. To make sure that this information covers all residents the registered persons must remind staff to record the food provided to those residents who require a special diet including those people on a soft or liquidised diet. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 To ensure that residents feel confident that any concern or complaint will be taken seriously the home has in place a clear complaints procedure. Staff training and reporting procedures are in place to protect residents from abuse. EVIDENCE: The home has a clear complaints procedure with timescales for responding to complaints with information on what action to take should a complainant not be satisfied with the response received from the home. The contact details of the Commission are included in the complaints procedure. Should the complaints process change due to the new owners of the home the registered persons should ensure that all residents are provided with the updated procedure. The manager keeps a record of any complaints made with information on the actions taken and outcomes. The complaints procedure and recording ensures that residents can be confident any concerns they express will be taken seriously and acted upon. The home manager informed the inspector that no complaints had been received by the home since the last inspection. One visitor to the home stated that they had brought a concern to the manager and that the issue had been resolved quickly. Policies and procedures are in place to ensure that all staff are aware of their responsibilities and actions to be taken should they suspect abuse of any resident. In addition a copy of the local authority policies and procedures was Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 15 seen to be on display in each unit. The manager reported that all staff working in the home have received training on the protection of vulnerable adults. The procedures in place along with staff training ensures that staff are aware of the types of abuse which can occur and the actions they need to take. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 Residents are provided with a comfortable well maintained environment. EVIDENCE: The design of this home, with a large unit on each floor, does not lend itself to providing a “homely” environment. However the building is well maintained and comfortable. Each resident is provided with their own single bedroom accommodation with en suite toilet facilities which provides privacy for individuals. A number of residents were seen to have personalised their own rooms according to their own taste and interests. The home has a variety of assisted washing facilities both baths and showers. Handrails are available throughout the home to assist residents with mobility and promote independence. All areas of the home seen at the time of this inspection were clean, tidy and free from offensive odours. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 17 The home employs a maintenance person who makes regular checks on the premises. This ensures that the environment for residents is well maintained. One resident raised concerns regarding an ill fitting window which caused a draught in their room. The manager informed the inspectors that staff were aware of this and action would be taken to resolve the problem. … Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 The home was seen to have sufficient staff on duty to meet the needs of the present resident groups. The recruitment procedures assist in protecting residents. Opportunities are available for staff to attend training courses. Future training plans should include training to meet the specific needs of this home. EVIDENCE: Residents gave very positive comments on the staff. Staff were described as “wonderful”, “very nice”, “polite” and “respectful”. Two qualified nurses are available on the nursing unit mornings and evenings with eight carers in the mornings and four carers in the evening. At night two qualified staff and two carers are on duty. On the residential unit five carers are available in the morning with four carers available in the evening. Two carers are on duty at night. These staffing levels were seen to be sufficient to meet the needs of the residents in the home at the time of this visit. The home carries out appropriate checks including Criminal Records Bureau checks on staff prior to them starting work in the home. This process helps to ensure the protection of residents. Staff spoken to had taken part in fire safety and protection of vulnerable adults training. Staff have also been supplied with health and safety and food safety Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 19 packs. The majority of staff spoken to confirmed they have received training on moving and handling. Senior staff are taking part in development training. Future training planning must be developed to ensure that the training supplied to each member of staff includes statutory training and address specific training issues for the home such as dementia care and person centred planning. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 & 38 The lack of appropriate supervision for staff providing direct care to residents leaves a gap in the systems for the protection of residents. Checks are carried out on the building and equipment to ensure the health and safety of residents, staff and visitors to the home. Staff must take care that rooms which are not to be open to residents remain locked. EVIDENCE: Staff providing direct care to residents must be provided with one to one supervision from a more senior member of staff at least six times each year. It is important that all staff are provided with regular supervision to ensure consistency, to identify training and development needs and to monitor work with individual residents. Regular checks are carried out on equipment and the building to ensure the safety of residents, staff and visitors to the home. Records showed weekly Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 21 checks on the fire alarm system, regular fire drills, checks on the temperature of food and checks on the water system for Legionella. It was noted that a clinical room on the first floor was left unattended and open. This room contained equipment and Steradent tablets which could pose a risk to residents or visitors to the home. Staff must ensure that this room is kept locked. Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 1 x 2 Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 5(1)(2) 12(1)(2) (3)(4) Requirement The registered persons must ensure that care planning for each individual includes information on the social, emotional and spiritual needs and wishes of residents with information on how these needs will be met. Evidence of consultation with residents and or their representatives must be available in relation to care planning. 2 OP7 5(1)(2) The registered persons must ensure that risk assessments and a full care plan are completed for any new residents within set timescales. 3 OP7 5(1)(2) The registered persons must ensure that all care plans are reviewed on a monthly basis or more frequently if required. 01/11/05 01/11/05 Timescale for action 15/12/05 Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 24 4 OP7 17(1)(a) Schedule 3, 12(1) 01/11/05 The registered persons must ensure that any record of care provided gives clear information on the nature of the care and any outcomes. 15/12/05 The registered persons must ensure that the wishes of residents in relation to actions to be taken after death are recorded and complied with. (timescale of 21.02.05 not met) 5 OP11 12(2) 6 OP12 12(4) The registered persons must ensure that the needs of residents in relation to attending religious centres are recorded and addressed. Should the home be unable to support residents to attend religious centres or arrange for visits from religious representatives this must be clearly stated in the information provided to residents prior to admission. 15/12/05 7 OP15 17(2) Schedule 4 (13) 01/11/05 The registered persons must ensure that a clear record of food is maintained for all residents including those people on a special diet or who require a soft or liquidised diet. 15/12/05 The registered persons must ensure that staff are provided with appropriate training to meet the needs of the resident group. All staff must be provided with training on dementia care. 8 OP30 18(1)(c) Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 25 9 OP36 18(2) The registered persons must ensure that all staff providing direct care receive planned one to one supervision from a more senior member of staff at least six times each year. (timescales of 10.08.04 and 21.02.05 not met) The registered persons must ensure that storage areas which are not to be accessible to residents or visitors to the home are kept locked when not occupied by staff. 15/12/05 10 OP38 13 01/11/05 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 OP7 Good Practice Recommendations Consideration should be give to providing training to all care staff on person centred planning to enable care staff to compile care plans with the support of the care coordinator. Consideration should be given to the provision of an appropriate vehicle to enable residents to access community activities and facilities. 2 OP12 Fieldway DS0000019090.V253476.R01.S.doc Version 5.0 Page 26 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.V253476.R01.S.doc Version 5.0 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!